CMS Price Transparency Data
Psychiatric evaluation (first visit)
Facility: Saint Mary's Hospital
Billing Code: 90791 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 90791
- Insurance Median: $138
- Cash Discount Price: $337
- vs. Medicare Baseline: 0.76x Medicare
The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Saint Mary's Hospital is $138. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $337. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.76x the Medicare baseline. Located in 56 Franklin Street, Waterbury, CT.
Cash / Self-Pay
$337
Average discount available for prompt cash payment at this facility.
Insurance Median
$138
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$181.34
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $181.34 (100%)
Cash / Self-Pay: $337 (186%)
Insurance Median: $138 (76%)
Cash: $337 (186% of Medicare)
Ins. Median: $138 (76% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $181.34 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 |
|---|---|---|
| Aetna | $51 - $504 | 28% |
| Albany County Correctional Facility | $51 - $70 | 28% |
| Ambetter / Centene | $51 - $70 | 28% |
| Amish Mennonite | $51 - $70 | 28% |
| Ascension St. Vincent Public Safety Medical | $51 - $70 | 28% |
| Bcccp-Michigan | $51 - $70 | 28% |
| Bccp | $51 - $70 | 28% |
| Blue Cross Blue Shield | $51 - $138 | 28% |
| Bmc Healthnet | $51 - $70 | 28% |
| Breast Grant-Connecticut | $51 - $70 | 28% |
| Broward County Dept of Health | $51 - $70 | 28% |
| California Health and Wellness | $51 - $70 | 28% |
| Can Community Health Inc | $51 - $70 | 28% |
| Cardinal Innovations Lme | $51 - $70 | 28% |
| Care Connections of Northern Iowa | $51 - $70 | 28% |
| Care Oregon Ohp | $51 - $70 | 28% |
| Cencal Health Plan | $51 - $70 | 28% |
| Cenpatico | $51 - $70 | 28% |
| Chhuny | $51 - $70 | 28% |
| Childrens Comm Health Plan | $51 - $70 | 28% |
| Childrens Medical Services Title 19 | $51 - $70 | 28% |
| Cigna | $51 - $510 | 28% |
| City of Philadelphia | $51 - $70 | 28% |
| Cmh Allegan County | $51 - $70 | 28% |
| Cmh Ausable Valley | $51 - $70 | 28% |
| Cmh Barry County | $51 - $70 | 28% |
| Cmh Bay-Arenac County | $51 - $70 | 28% |
| Cmh Berrien County | $51 - $70 | 28% |
| Cmh Cass County | $51 - $70 | 28% |
| Cmh Central Mi County | $51 - $70 | 28% |
| Cmh Clinton-Eaton-Ingham County | $51 - $70 | 28% |
| Cmh Detroit Wayne Integrated Health Network | $51 - $70 | 28% |
| Cmh Genesee County | $51 - $70 | 28% |
| Cmh Ionia County | $51 - $70 | 28% |
| Cmh Jackson County/Lifeways | $51 - $70 | 28% |
| Cmh Kalamazoo | $51 - $70 | 28% |
| Cmh Kent County | $51 - $70 | 28% |
| Cmh Lenawee County | $51 - $70 | 28% |
| Cmh Livingston County | $51 - $70 | 28% |
| Cmh Macomb | $51 - $70 | 28% |
| Cmh Misc | $51 - $70 | 28% |
| Cmh Monroe County | $51 - $70 | 28% |
| Cmh Montcalm County | $51 - $70 | 28% |
| Cmh Muskegon County | $51 - $70 | 28% |
| Cmh Newaygo County | $51 - $70 | 28% |
| Cmh North Country | $51 - $70 | 28% |
| Cmh Northern Lakes County | $51 - $70 | 28% |
| Cmh Oakland County | $51 - $70 | 28% |
| Cmh Ottawa County | $51 - $70 | 28% |
| Cmh Van Buren County | $51 - $70 | 28% |
| Cmh Washtenaw County | $51 - $70 | 28% |
| Cmh Wayne County/Carelink | $51 - $70 | 28% |
| Cmh Wayne Cty/Com Liv Svcs | $51 - $70 | 28% |
| Cmh West Mi County | $51 - $70 | 28% |
| Community Benefit Health | $51 - $70 | 28% |
| Community Care Behavorial Health | $51 - $70 | 28% |
| Community Care Partners | $51 - $70 | 28% |
| Community Health Choice | $51 - $70 | 28% |
| Connections Csp | $51 - $70 | 28% |
| County Coroner | $51 - $70 | 28% |
| County Funding Generic | $51 - $70 | 28% |
| Covid19 Hrsa Uninsured Testing and Treatment Fund | $51 - $70 | 28% |
| Dean Wi Badgercare | $51 - $70 | 28% |
| Delaware County Department of Health | $51 - $70 | 28% |
| Delaware First Health | $51 - $70 | 28% |
| Dph Tb Program | $51 - $70 | 28% |
| Dscc | $51 - $70 | 28% |
| Eastpointe Lme | $51 - $70 | 28% |
| Family Health Network | $51 - $70 | 28% |
| Freedom First Healthcare | $51 - $70 | 28% |
| Fresno County Ccs | $51 - $70 | 28% |
| Ghc Scw Wi Badgercare | $51 - $70 | 28% |
| Harbor Health | $51 - $70 | 28% |
| Health Safety Net | $51 - $70 | 28% |
| Healthy Blue Ne | $51 - $70 | 28% |
| Hennepin Health | $51 - $70 | 28% |
| Humana | $51 - $142 | 28% |
| Id County Ada | $51 - $70 | 28% |
| Id County Canyon | $51 - $70 | 28% |
| Id County Cat Fund | $51 - $70 | 28% |
| Id County Other | $51 - $70 | 28% |
| Id County Payette | $51 - $70 | 28% |
| Idaho Dept Health and Wellfare | $51 - $70 | 28% |
| Idaho Womens Health Check | $51 - $70 | 28% |
| Indiana Breast Cervical Cancer | $51 - $70 | 28% |
| Inland Empire Health Plan | $51 - $70 | 28% |
| Intercommunity Health Ohp | $51 - $70 | 28% |
| Iowa Total Care | $51 - $70 | 28% |
| Jai Medical System | $51 - $70 | 28% |
| Kern Family Health Plan | $51 - $70 | 28% |
| Keystone First | $51 - $70 | 28% |
| Keystone First Chip | $51 - $70 | 28% |
| La Care Health Plan | $51 - $70 | 28% |
| Lakeland Care Inc | $51 - $70 | 28% |
| Managed Health Services - Indiana | $51 - $70 | 28% |
| Maryland Breast & Cervical Program | $51 - $70 | 28% |
| Maryland Healthy Smiles - Scion Dental | $51 - $70 | 28% |
| Maryland Physicians Care | $51 - $70 | 28% |
| Massachusetts Behavioral Health Partnership | $51 - $70 | 28% |
| Mdwise | $51 - $70 | 28% |
| Medi-Cal | $51 - $70 | 28% |
| Medi-Cal Healthnet | $51 - $70 | 28% |
| Medicaid / KanCare | $51 - $441 | 28% |
| Medstar Dc Healthy Family | $51 - $70 | 28% |
| Medstar Md Health Choice | $51 - $70 | 28% |
| Mo Home State Health Plan | $51 - $70 | 28% |
| Molina Centennial Care | $51 - $70 | 28% |
| Nascentia Health Options | $51 - $70 | 28% |
| Nebraska Total Care | $51 - $70 | 28% |
| New York Cancer Services Program | $51 - $70 | 28% |
| Nextlevel Health | $51 - $70 | 28% |
| Oregon Screenwise | $51 - $70 | 28% |
| Pace of Southwest Michigan | $51 - $138 | 28% |
| Paramount Advantage | $51 - $70 | 28% |
| Parkland Community Health Plan | $51 - $70 | 28% |
| Partners Behavioral Lme | $51 - $70 | 28% |
| Peach State Healthplan | $51 - $70 | 28% |
| Philadelphia County Funding | $51 - $70 | 28% |
| Presbyterian Centennial Care | $51 - $70 | 28% |
| Prestige Health Choice | $51 - $70 | 28% |
| Priority Partners | $51 - $70 | 28% |
| Robert F Sing Program | $51 - $70 | 28% |
| Rx 340B Pass Along | $51 - $70 | 28% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $51 - $70 | 28% |
| Rx Medi-Cal | $51 - $70 | 28% |
| Rx Meridian Rx | $51 - $70 | 28% |
| Ryan White Florida Mssrp | $51 - $70 | 28% |
| Sandhills Center Lme | $51 - $70 | 28% |
| Screening for Life | $51 - $70 | 28% |
| St Joseph County Hlth Dpt | $51 - $70 | 28% |
| Stephenson Cty Health | $51 - $70 | 28% |
| Sunshine State Health Plan | $51 - $70 | 28% |
| Superior Health | $51 - $70 | 28% |
| Tenncare | $51 - $70 | 28% |
| Texas Children's Health Plan | $51 - $70 | 28% |
| Trillium Community Ohp | $51 - $70 | 28% |
| Tufts Health Public Plans | $51 - $70 | 28% |
| UnitedHealthcare | $51 - $638 | 28% |
| Vaya Health Lme | $51 - $70 | 28% |
| Washtenaw Health Plan | $51 - $70 | 28% |
| Wellsense Health Plan | $51 - $70 | 28% |
| Wi Womens Wellness | $51 - $70 | 28% |
| Align Senior Care | $103 - $138 | 57% |
| Ally Align Care Adv | $103 - $138 | 57% |
| American Health Advantage of Idaho | $103 - $138 | 57% |
| American Health Plan | $103 - $138 | 57% |
| Aurora Special Needs | $103 - $138 | 57% |
| Blue Care Network Advantage | $103 - $138 | 57% |
| Blue Shield - De (Highmark) Medciare Advantage | $103 - $138 | 57% |
| Care Dimensions | $103 - $138 | 57% |
| Care Improvement Plus | $103 - $138 | 57% |
| Care Resources Pace | $103 - $138 | 57% |
| Careplus Health Plans | $103 - $138 | 57% |
| Cca - Zing Health | $103 - $138 | 57% |
| Central Valley Medical Services Corp Pace | $103 - $138 | 57% |
| Champion Health Plan McR Advantage | $103 - $138 | 57% |
| Clear Spring Health | $103 - $138 | 57% |
| Clover Health | $103 - $138 | 57% |
| Commonwealth Care Alliance | $103 - $152 | 57% |
| Community Pace at Home | $103 - $138 | 57% |
| Eddy Senior Care-Pace | $103 - $138 | 57% |
| Eddy Seniorcare Pace | $103 - $138 | 57% |
| Elementcare | $103 - $138 | 57% |
| Evercare | $103 - $138 | 57% |
| Everence | $103 - $138 | 57% |
| Gateway Health Plan | $103 - $138 | 57% |
| Genesys Pace of Genesee County | $103 - $138 | 57% |
| Georgia Health Advantage | $103 - $138 | 57% |
| Gold Advantage | $103 - $138 | 57% |
| Gpa Croell Redi Mix | $103 - $138 | 57% |
| Health America Advantra | $103 - $138 | 57% |
| Highmark Health Options Dual Plan | $103 - $138 | 57% |
| Hope Select Pace | $103 - $138 | 57% |
| Horizon Nj Total Care | $103 - $138 | 57% |
| Hudson Headwaters Pace | $103 - $138 | 57% |
| Huron Valley Pace | $103 - $138 | 57% |
| Innovative Integrated Health Community Plans | $103 - $138 | 57% |
| Iowa Health Advantage | $103 - $138 | 57% |
| Johns Hopkins Advantage Md | $103 - $138 | 57% |
| Lasso Healthcare Msa | $103 - $138 | 57% |
| Life St Marys Pace | $103 - $138 | 57% |
| Lifecircles Pace | $103 - $138 | 57% |
| Longevity Health Plan | $103 - $138 | 57% |
| Longevity IPA of Michigan LLC Health Plan Isnp | $103 - $138 | 57% |
| Martins Point Generations Advantage | $103 - $138 | 57% |
| Mass General Brigham McR Adv | $103 - $138 | 57% |
| Medicare (plans) | $103 - $156 | 57% |
| Medipak Advantage | $103 - $138 | 57% |
| Mercy Life | $103 - $138 | 57% |
| Mercyone Cedar Valley | $103 - $138 | 57% |
| Meridian Complete | $103 - $138 | 57% |
| Michigan Complete Health | $103 - $138 | 57% |
| Nascentia Health Plus | $103 - $138 | 57% |
| New Centry Health Careplus | $103 - $138 | 57% |
| Osu Prime Care Advantage | $103 - $138 | 57% |
| Pace Cny | $103 - $138 | 57% |
| Pace Iowa Immanuel Pathways | $103 - $138 | 57% |
| Pace Southeast | $103 - $138 | 57% |
| Pace-Trinity Health | $103 - $138 | 57% |
| Peak Pace Solutions | $103 - $138 | 57% |
| Perennial Advantage | $103 - $138 | 57% |
| Preferred Care Partners | $103 - $138 | 57% |
| Presbyterian Senior Plan | $103 - $138 | 57% |
| Provider Partners Health Plan of Illinois | $103 - $138 | 57% |
| Provider Partners Health Plan of Indiana | $103 - $138 | 57% |
| Pruitthealth Premier | $103 - $138 | 57% |
| Reliance Community Care Partners Care Resources Pace | $103 - $138 | 57% |
| Rx Allwin | $103 - $138 | 57% |
| Rx Grane Grnmedd | $103 - $138 | 57% |
| Rx Retiree Rx Care | $103 - $138 | 57% |
| Scan Health Plan McR IPA Meritage Oon | $103 - $138 | 57% |
| Secure Horizons Ma Pffs | $103 - $138 | 57% |
| Serenity Pace | $103 - $138 | 57% |
| Siouxland Pace | $103 - $138 | 57% |
| Solis Health Plans | $103 - $138 | 57% |
| Sunnyview-Pace Finance Dept | $103 - $138 | 57% |
| Texan Plus | $103 - $138 | 57% |
| The Health Plan | $103 - $138 | 57% |
| Thome Pace | $103 - $138 | 57% |
| Todays Options | $103 - $138 | 57% |
| Tribute Health Plans | $103 - $138 | 57% |
| Um Health Advantage | $103 - $138 | 57% |
| Union Health Service | $103 - $138 | 57% |
| Welbe Health | $103 - $138 | 57% |
| Wellmed | $103 - $138 | 57% |
| Veterans Administration | $105 - $141 | 58% |
| Champva | $106 - $142 | 58% |
| Tricare | $106 - $142 | 58% |
| Triwest Health Alliance | $106 - $142 | 58% |
| Veterans Eval Services | $106 - $142 | 58% |
| Cca Senior Care Options | $112 - $149 | 62% |
| Bcn Domestic | $117 | 65% |
| Blue Benefit Administrators of Massachusetts | $117 | 65% |
| Blue Care Network | $117 | 65% |
| Blue Distinction Transplant | $117 | 65% |
| Blue Shield - Ca | $117 | 65% |
| Blue Shield - Id (Regence) | $117 | 65% |
| Blue Shield - Ny Highmark Northeastern | $117 | 65% |
| Blue Shield - Ny Highmark Western | $117 | 65% |
| Blue Shield - PA (Highmark) | $117 | 65% |
| Blue Shield - Wa (Regence) | $117 | 65% |
| Health Choices | $117 | 65% |
| Kaiser Domestic | $117 | 65% |
| Pre-Employment | $117 | 65% |
| Wc Domestic | $117 | 65% |
| Coventry | $125 - $291 | 69% |
| First Health | $125 - $291 | 69% |
| Guardian | $125 - $291 | 69% |
| Meritain | $125 - $504 | 69% |
| Health New England | $137 - $338 | 76% |
| Us Family Health Plan | $148 - $312 | 82% |
| Fallon Health | $182 - $491 | 100% |
| Claimdoc | $185 - $246 | 102% |
| Innovative Health Plan II | $185 - $246 | 102% |
| Multiplan | $194 - $491 | 107% |
| Connecticut Dept of Correction | $197 | 109% |
| Mass General Brigham Health Plan | $215 - $314 | 119% |
| Unicare | $222 - $244 | 122% |
| Wellpoint | $222 - $244 | 122% |
| Harvard Pilgrim Healthcare | $247 - $588 | 136% |
| Healthscope | $251 - $295 | 138% |
| Health Smart | $261 - $542 | 144% |
| Wc Corvel | $261 - $375 | 144% |
| Connecticare | $266 - $638 | 147% |
| Prime Health Services | $287 - $510 | 158% |
| Carelon Behavioral Health | $294 - $319 | 162% |
| Andrie Inc | $299 | 165% |
| East Greenbush Central School District | $299 | 165% |
| Genex Wc | $299 | 165% |
| Healthsmart Workers Comp | $299 | 165% |
| Jag Source | $299 | 165% |
| New York State Insurance Fund | $299 | 165% |
| Njm Insurance Group | $299 | 165% |
| Rx Heatlhcomp | $299 | 165% |
| Rx Restat | $299 | 165% |
| Rx Saif Opdp Wc | $299 | 165% |
| Rx Worker's Comp | $299 | 165% |
| Wc Accident Fund | $299 | 165% |
| Wc Ace | $299 | 165% |
| Wc Acs Federal Employees | $299 | 165% |
| Wc Acuity | $299 | 165% |
| Wc Advantage | $299 | 165% |
| Wc Aegis | $299 | 165% |
| Wc Aig | $299 | 165% |
| Wc Aims | $299 | 165% |
| Wc Alaska National Ins | $299 | 165% |
| Wc Align Network | $299 | 165% |
| Wc Allied | $299 | 165% |
| Wc Am Trust N America | $299 | 165% |
| Wc American Claims Mgmt | $299 | 165% |
| Wc Amerisure | $299 | 165% |
| Wc Amtrust | $299 | 165% |
| Wc Asu Risk Mgt | $299 | 165% |
| Wc Benetech | $299 | 165% |
| Wc Berkley Admin | $299 | 165% |
| Wc Broadspire | $299 | 165% |
| Wc Broward County | $299 | 165% |
| Wc Bunch & Associates | $299 | 165% |
| Wc California State Comp Ins | $299 | 165% |
| Wc California State Ins Fund | $299 | 165% |
| Wc Capitol Area Health Consortium | $299 | 165% |
| Wc Ccmsi | $299 | 165% |
| Wc Chartis | $299 | 165% |
| Wc Chubb | $299 | 165% |
| Wc Cirma | $299 | 165% |
| Wc City of Albany | $299 | 165% |
| Wc City of Sioux City | $299 | 165% |
| Wc Claims Mgmt Inc | $299 | 165% |
| Wc Cna | $299 | 165% |
| Wc Comp One Admin C/O Manageability | $299 | 165% |
| Wc Compone Admin | $299 | 165% |
| Wc Ct Healthcare Trust | $299 | 165% |
| Wc Donegal Insurance Group | $299 | 165% |
| Wc Emc Insurance Company | $299 | 165% |
| Wc Employee Mutual | $299 | 165% |
| Wc Enablecomp | $299 | 165% |
| Wc Encore Health Network | $299 | 165% |
| Wc Erie | $299 | 165% |
| Wc Esis | $299 | 165% |
| Wc Evolutions | $299 | 165% |
| Wc Fcci | $299 | 165% |
| Wc Fed Ex | $299 | 165% |
| Wc Federal Black Lung | $299 | 165% |
| Wc Federated | $299 | 165% |
| Wc Finley Occupational Health | $299 | 165% |
| Wc First Agency/Occunet | $299 | 165% |
| Wc Ford Motor | $299 | 165% |
| Wc Fresno Unified Emp | $299 | 165% |
| Wc Gallagher Bassett | $299 | 165% |
| Wc General Motors | $299 | 165% |
| Wc Generic | $299 | 165% |
| Wc Genex Care for Ohio | $299 | 165% |
| Wc Great West Casualty | $299 | 165% |
| Wc Guarantee Insurance | $299 | 165% |
| Wc Guard Insurance Company | $299 | 165% |
| Wc Hab | $299 | 165% |
| Wc Hartford | $299 | 165% |
| Wc Hastings | $299 | 165% |
| Wc Health Management | $299 | 165% |
| Wc Heritage Summit | $299 | 165% |
| Wc Hireright | $299 | 165% |
| Wc Horizon | $299 | 165% |
| Wc Icw Group | $299 | 165% |
| Wc Idaho State Ins Fund | $299 | 165% |
| Wc Intercare Insurance | $299 | 165% |
| Wc Intermountain | $299 | 165% |
| Wc Johns Eastern | $299 | 165% |
| Wc Kemberton | $299 | 165% |
| Wc Key Ins & Benefit Solutions | $299 | 165% |
| Wc Liberty Mutual | $299 | 165% |
| Wc Mac Risk Management | $299 | 165% |
| Wc Massachusetts | $299 | 165% |
| Wc Mdia | $299 | 165% |
| Wc Meadowbrook Claim | $299 | 165% |
| Wc Medical Administrators | $299 | 165% |
| Wc Meijers | $299 | 165% |
| Wc Memic | $299 | 165% |
| Wc Mercy Workcare | $299 | 165% |
| Wc Michigan | $299 | 165% |
| Wc Michigan Millers Mutual | $299 | 165% |
| Wc Mitchell Frankenmuth | $299 | 165% |
| Wc Mra | $299 | 165% |
| Wc Nationwide | $299 | 165% |
| Wc Nca Comp | $299 | 165% |
| Wc New York | $299 | 165% |
| Wc New York Special Funds | $299 | 165% |
| Wc North American Rishces | $299 | 165% |
| Wc Northeast Health | $299 | 165% |
| Wc Notre Dame | $299 | 165% |
| Wc Novanet | $299 | 165% |
| Wc O'Hara Corp | $299 | 165% |
| Wc Occ Health Allen | $299 | 165% |
| Wc Ohio Bureau | $299 | 165% |
| Wc One Call Medical | $299 | 165% |
| Wc Paradigm | $299 | 165% |
| Wc Peerless | $299 | 165% |
| Wc Pma | $299 | 165% |
| Wc Praxis Health Network | $299 | 165% |
| Wc Price Chopper | $299 | 165% |
| Wc Procura Management | $299 | 165% |
| Wc Qualcare | $299 | 165% |
| Wc Quiktrip | $299 | 165% |
| Wc Reny Company | $299 | 165% |
| Wc Rev Claims | $299 | 165% |
| Wc Risico | $299 | 165% |
| Wc Rural Mutual | $299 | 165% |
| Wc Saif Oregon | $299 | 165% |
| Wc Secura | $299 | 165% |
| Wc Sedgwick | $299 | 165% |
| Wc Sentry | $299 | 165% |
| Wc Sheakley Unicomp | $299 | 165% |
| Wc Smile Lodge | $299 | 165% |
| Wc Society | $299 | 165% |
| Wc Srs | $299 | 165% |
| Wc Taconic (Mro) | $299 | 165% |
| Wc Taconic Farms | $299 | 165% |
| Wc Travelers | $299 | 165% |
| Wc Triad Group | $299 | 165% |
| Wc Tristar | $299 | 165% |
| Wc Troy Ny | $299 | 165% |
| Wc Tyson | $299 | 165% |
| Wc Unified Health Services | $299 | 165% |
| Wc United Heartland | $299 | 165% |
| Wc Us Dept of Labor | $299 | 165% |
| Wc Velocity | $299 | 165% |
| Wc Walmart | $299 | 165% |
| Wc West Bend | $299 | 165% |
| Wc West Bend Mutual/Argent | $299 | 165% |
| Wc Winnebago Industries | $299 | 165% |
| Wc Yankee Trails | $299 | 165% |
| Wc York Risk | $299 | 165% |
| Wc Zenith | $299 | 165% |
| Wc Zurich | $299 | 165% |
| Centivo | $307 - $323 | 169% |
| Delta Dental Ga | $307 - $441 | 169% |
| Delta Dental Mi | $307 - $441 | 169% |
| Delta Dental Mo | $307 - $441 | 169% |
| Delta Dental Nj | $307 - $441 | 169% |
| Delta Dental Ny | $307 - $441 | 169% |
| Delta Dental Oh | $307 - $441 | 169% |
| Delta Dental Or | $307 - $441 | 169% |
| Delta Dental PA | $307 - $441 | 169% |
| Delta Dental VA | $307 - $441 | 169% |
| Delta Dental Wa | $307 - $441 | 169% |
| Liberty Dental | $307 - $441 | 169% |
| Tufts Health Plan | $307 - $312 | 169% |
| Allegiance | $318 - $345 | 175% |
| Health Partners | $318 - $345 | 175% |
| Magnacare | $318 - $345 | 175% |
| Allied National Global Care | $453 - $491 | 250% |
| Asrm - Reliance Standard Life Insurance | $453 - $491 | 250% |
| Christian Care Ministry | $453 - $491 | 250% |
| Dean Health | $453 - $491 | 250% |
| Family Life Insurance Company | $453 - $491 | 250% |
| Ghc Scw | $453 - $491 | 250% |
| International Benefit Administrators | $453 - $491 | 250% |
| Lifetime Benefit Solutions | $453 - $491 | 250% |
| Manhattan Life | $453 - $491 | 250% |
| Medi Share | $453 - $491 | 250% |
| Mvp | $453 - $491 | 250% |
| PHCS | $453 - $491 | 250% |
| Pai | $453 - $491 | 250% |
| Pan-American Life | $453 - $491 | 250% |
| Paramount HMO | $453 - $491 | 250% |
| Trinity Health Share | $453 - $491 | 250% |
| 1199 National Benefit Fund | $465 - $504 | 256% |
| Allied Benefit Systems | $465 - $504 | 256% |
| Gravie Admin Services | $465 - $504 | 256% |
| Hap | $465 - $504 | 256% |
| Luminare Health | $465 - $504 | 256% |
| Nippon Life Ins | $465 - $504 | 256% |
| Webtpa | $465 - $504 | 256% |
| Geha | $517 - $588 | 285% |
| United Behavioral Health Eap | $588 - $638 | 324% |