CMS Price Transparency Data
Total hip replacement
Facility: Mercyone Waterloo Medical Center
Billing Code: 27130 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 27130
- Insurance Median: $544
- Cash Discount Price: $1,865
- vs. Medicare Baseline: 0.04x Medicare
The contracted insurance negotiated median rate for a Total hip replacement at Mercyone Waterloo Medical Center is $544. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,865. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.04x the Medicare baseline. Located in 3421 West Ninth Street, Waterloo, IA.
Cash / Self-Pay
$1,865
Average discount available for prompt cash payment at this facility.
Insurance Median
$544
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$13,116.76
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $13,116.76 (100%)
Cash / Self-Pay: $1,865 (14%)
Insurance Median: $544 (4%)
Cash: $1,865 (14% of Medicare)
Ins. Median: $544 (4% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $13,116.76 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 |
|---|---|---|
| Wc Corvel | $119 - $746 | 1% |
| Aetna | $123 - $12,096 | 1% |
| Align Senior Care | $123 - $770 | 1% |
| Ally Align Care Adv | $123 - $770 | 1% |
| American Health Advantage Of Idaho | $123 - $770 | 1% |
| Aurora Special Needs | $123 - $770 | 1% |
| Blue Care Network Advantage | $123 - $770 | 1% |
| Blue Cross Blue Shield | $123 - $13,117 | 1% |
| Blue Shield - De (Highmark) Medciare Advantage | $123 - $770 | 1% |
| Care Dimensions | $123 - $770 | 1% |
| Care Improvement Plus | $123 - $770 | 1% |
| Care Resources Pace | $123 - $770 | 1% |
| Careplus Health Plans | $123 - $770 | 1% |
| Cca - Zing Health | $123 - $770 | 1% |
| Cca Senior Care Options | $123 - $770 | 1% |
| Central Valley Medical Services Corp Pace | $123 - $770 | 1% |
| Champion Health Plan Mcr Advantage | $123 - $770 | 1% |
| Cigna | $123 - $2,586 | 1% |
| Clear Spring Health | $123 - $770 | 1% |
| Clover Health | $123 - $770 | 1% |
| Commonwealth Care Alliance | $123 - $770 | 1% |
| Community Pace At Home | $123 - $770 | 1% |
| Eddy Senior Care-Pace | $123 - $770 | 1% |
| Eddy Seniorcare Pace | $123 - $770 | 1% |
| Elementcare | $123 - $770 | 1% |
| Evercare | $123 - $770 | 1% |
| Everence | $123 - $770 | 1% |
| Gateway Health Plan | $123 - $770 | 1% |
| Genesys Pace Of Genesee County | $123 - $770 | 1% |
| Georgia Health Advantage | $123 - $770 | 1% |
| Gold Advantage | $123 - $770 | 1% |
| Gpa Croell Redi Mix | $123 - $770 | 1% |
| Health America Advantra | $123 - $770 | 1% |
| Highmark Health Options Dual Plan | $123 - $770 | 1% |
| Hope Select Pace | $123 - $770 | 1% |
| Horizon Nj Total Care | $123 - $770 | 1% |
| Hudson Headwaters Pace | $123 - $770 | 1% |
| Humana | $123 - $1,257 | 1% |
| Huron Valley Pace | $123 - $770 | 1% |
| Innovative Integrated Health Community Plans | $123 - $770 | 1% |
| Johns Hopkins Advantage Md | $123 - $770 | 1% |
| Lasso Healthcare Msa | $123 - $770 | 1% |
| Life St Marys Pace | $123 - $770 | 1% |
| Lifecircles Pace | $123 - $770 | 1% |
| Longevity Health Plan | $123 - $770 | 1% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $123 - $770 | 1% |
| Martins Point Generations Advantage | $123 - $770 | 1% |
| Mass General Brigham Mcr Adv | $123 - $770 | 1% |
| Medicare (plans) | $123 - $12,589 | 1% |
| Medipak Advantage | $123 - $770 | 1% |
| Mercy Life | $123 - $770 | 1% |
| Mercyone Cedar Valley | $123 - $770 | 1% |
| Meridian Complete | $123 - $770 | 1% |
| Michigan Complete Health | $123 - $770 | 1% |
| Nascentia Health Plus | $123 - $770 | 1% |
| New Centry Health Careplus | $123 - $770 | 1% |
| Osu Prime Care Advantage | $123 - $770 | 1% |
| Pace Cny | $123 - $770 | 1% |
| Pace Iowa Immanuel Pathways | $123 - $770 | 1% |
| Pace Of Southwest Michigan | $123 - $1,046 | 1% |
| Pace Southeast | $123 - $770 | 1% |
| Pace-Trinity Health | $123 - $770 | 1% |
| Peak Pace Solutions | $123 - $770 | 1% |
| Perennial Advantage | $123 - $770 | 1% |
| Preferred Care Partners | $123 - $770 | 1% |
| Presbyterian Senior Plan | $123 - $770 | 1% |
| Provider Partners Health Plan Of Illinois | $123 - $770 | 1% |
| Provider Partners Health Plan Of Indiana | $123 - $770 | 1% |
| Pruitthealth Premier | $123 - $770 | 1% |
| Reliance Community Care Partners Care Resources Pace | $123 - $770 | 1% |
| Rx Allwin | $123 - $770 | 1% |
| Rx Grane Grnmedd | $123 - $770 | 1% |
| Rx Retiree Rx Care | $123 - $770 | 1% |
| Scan Health Plan Mcr Ipa Meritage Oon | $123 - $770 | 1% |
| Secure Horizons Ma Pffs | $123 - $770 | 1% |
| Serenity Pace | $123 - $770 | 1% |
| Siouxland Pace | $123 - $770 | 1% |
| Solis Health Plans | $123 - $770 | 1% |
| Sunnyview-Pace Finance Dept | $123 - $770 | 1% |
| Texan Plus | $123 - $770 | 1% |
| The Health Plan | $123 - $770 | 1% |
| Thome Pace | $123 - $770 | 1% |
| Todays Options | $123 - $770 | 1% |
| Tribute Health Plans | $123 - $770 | 1% |
| Um Health Advantage | $123 - $770 | 1% |
| Union Health Service | $123 - $770 | 1% |
| UnitedHealthcare | $123 - $12,337 | 1% |
| Welbe Health | $123 - $770 | 1% |
| Wellmed | $123 - $770 | 1% |
| Veterans Administration | $126 - $785 | 1% |
| American Health Plan | $129 - $808 | 1% |
| Avera | $129 - $1,206 | 1% |
| Iowa Health Advantage | $129 - $808 | 1% |
| Champva | $138 - $860 | 1% |
| Tricare | $138 - $860 | 1% |
| Triwest Health Alliance | $138 - $860 | 1% |
| Us Family Health Plan | $138 - $860 | 1% |
| Veterans Eval Services | $138 - $860 | 1% |
| Medical Associates | $140 - $1,312 | 1% |
| Ambetter / Centene | $142 - $20,735 | 1% |
| Medicaid / KanCare | $148 - $12,469 | 1% |
| Sanford Health Plan | $149 - $1,394 | 1% |
| Health Partners | $150 - $2,111 | 1% |
| Lucent Health | $151 - $6,596 | 1% |
| Ucare | $151 - $1,415 | 1% |
| Health Smart | $155 - $1,453 | 1% |
| Oscar | $157 - $18,942 | 1% |
| Stephenson Cty Health | $161 - $1,007 | 1% |
| Quiktrip | $163 - $1,532 | 1% |
| Usa Managed Care | $163 - $1,524 | 1% |
| Amish Hospital Aid | $167 - $16,415 | 1% |
| Centivo | $168 - $20,488 | 1% |
| Amps | $170 - $1,060 | 1% |
| Claimdoc | $175 - $24,808 | 1% |
| The Alliance | $176 - $1,650 | 1% |
| Multiplan | $185 - $1,851 | 1% |
| Global Excel | $189 - $1,775 | 1% |
| Velocity | $197 - $1,846 | 2% |
| Bcn Domestic | $200 - $13,117 | 2% |
| Blue Benefit Administrators Of Massachusetts | $200 - $13,117 | 2% |
| Blue Care Network | $200 - $13,117 | 2% |
| Blue Distinction Transplant | $200 - $13,117 | 2% |
| Blue Shield - Ca | $200 - $13,117 | 2% |
| Blue Shield - Id (Regence) | $200 - $13,117 | 2% |
| Blue Shield - Ny Highmark Northeastern | $200 - $13,117 | 2% |
| Blue Shield - Ny Highmark Western | $200 - $13,117 | 2% |
| Blue Shield - Pa (Highmark) | $200 - $13,117 | 2% |
| Blue Shield - Wa (Regence) | $200 - $13,117 | 2% |
| Health Choices | $200 - $2,586 | 2% |
| Kaiser Domestic | $200 - $13,117 | 2% |
| Pre-Employment | $200 - $13,117 | 2% |
| Wc Domestic | $200 - $13,117 | 2% |
| Preferred One | $206 - $1,927 | 2% |
| Iowa Dept Of Public Health | $226 - $2,825 | 2% |
| Nebraska Total Care | $226 - $2,825 | 2% |
| Geha | $248 - $2,326 | 2% |
| Newton Correctional Facility | $294 - $3,672 | 2% |
| Meritain | $316 - $6,596 | 2% |
| Genex Wc | $339 - $4,238 | 3% |
| Allied Benefit Systems | $345 - $6,596 | 3% |
| Auxiant | $345 - $2,586 | 3% |
| First Choice Health | $345 - $2,586 | 3% |
| Group Administrators | $345 - $2,586 | 3% |
| Midlands | $345 - $2,586 | 3% |
| Midlands Choice | $345 - $2,586 | 3% |
| Wc Align Network | $362 - $4,520 | 3% |
| Wc Praxis Health Network | $384 - $4,802 | 3% |
| Wc Reny Company | $393 - $4,916 | 3% |
| Wc Velocity | $393 - $4,916 | 3% |
| Auto Velocity | $407 - $5,085 | 3% |
| Wc O'Hara Corp | $407 - $5,085 | 3% |
| Andrie Inc | $452 - $5,650 | 3% |
| East Greenbush Central School District | $452 - $5,650 | 3% |
| Healthsmart Workers Comp | $452 - $5,650 | 3% |
| Jag Source | $452 - $5,650 | 3% |
| New York State Insurance Fund | $452 - $5,650 | 3% |
| Njm Insurance Group | $452 - $5,650 | 3% |
| Rx Heatlhcomp | $452 - $5,650 | 3% |
| Rx Restat | $452 - $5,650 | 3% |
| Rx Saif Opdp Wc | $452 - $5,650 | 3% |
| Rx Worker'S Comp | $452 - $5,650 | 3% |
| Wc Accident Fund | $452 - $5,650 | 3% |
| Wc Ace | $452 - $5,650 | 3% |
| Wc Acs Federal Employees | $452 - $5,650 | 3% |
| Wc Acuity | $452 - $5,650 | 3% |
| Wc Advantage | $452 - $5,650 | 3% |
| Wc Aegis | $452 - $5,650 | 3% |
| Wc Aig | $452 - $5,650 | 3% |
| Wc Aims | $452 - $5,650 | 3% |
| Wc Alaska National Ins | $452 - $5,650 | 3% |
| Wc Allied | $452 - $5,650 | 3% |
| Wc Am Trust N America | $452 - $5,650 | 3% |
| Wc American Claims Mgmt | $452 - $5,650 | 3% |
| Wc Amerisure | $452 - $5,650 | 3% |
| Wc Amtrust | $452 - $5,650 | 3% |
| Wc Asu Risk Mgt | $452 - $5,650 | 3% |
| Wc Benetech | $452 - $5,650 | 3% |
| Wc Berkley Admin | $452 - $5,650 | 3% |
| Wc Broadspire | $452 - $5,650 | 3% |
| Wc Broward County | $452 - $5,650 | 3% |
| Wc Bunch & Associates | $452 - $5,650 | 3% |
| Wc California State Comp Ins | $452 - $5,650 | 3% |
| Wc California State Ins Fund | $452 - $5,650 | 3% |
| Wc Capitol Area Health Consortium | $452 - $5,650 | 3% |
| Wc Ccmsi | $452 - $5,650 | 3% |
| Wc Chartis | $452 - $5,650 | 3% |
| Wc Chubb | $452 - $5,650 | 3% |
| Wc Cirma | $452 - $5,650 | 3% |
| Wc City Of Albany | $452 - $5,650 | 3% |
| Wc City Of Sioux City | $452 - $5,650 | 3% |
| Wc Claims Mgmt Inc | $452 - $5,650 | 3% |
| Wc Cna | $452 - $5,650 | 3% |
| Wc Comp One Admin C/O Manageability | $452 - $5,650 | 3% |
| Wc Compone Admin | $452 - $5,650 | 3% |
| Wc Ct Healthcare Trust | $452 - $5,650 | 3% |
| Wc Donegal Insurance Group | $452 - $5,650 | 3% |
| Wc Emc Insurance Company | $452 - $5,650 | 3% |
| Wc Employee Mutual | $452 - $5,650 | 3% |
| Wc Enablecomp | $452 - $5,650 | 3% |
| Wc Encore Health Network | $452 - $5,650 | 3% |
| Wc Erie | $452 - $5,650 | 3% |
| Wc Esis | $452 - $5,650 | 3% |
| Wc Evolutions | $452 - $5,650 | 3% |
| Wc Fcci | $452 - $5,650 | 3% |
| Wc Fed Ex | $452 - $5,650 | 3% |
| Wc Federal Black Lung | $452 - $5,650 | 3% |
| Wc Federated | $452 - $5,650 | 3% |
| Wc Finley Occupational Health | $452 - $5,650 | 3% |
| Wc First Agency/Occunet | $452 - $5,650 | 3% |
| Wc Ford Motor | $452 - $5,650 | 3% |
| Wc Fresno Unified Emp | $452 - $5,650 | 3% |
| Wc Gallagher Bassett | $452 - $5,650 | 3% |
| Wc General Motors | $452 - $5,650 | 3% |
| Wc Generic | $452 - $5,650 | 3% |
| Wc Genex Care For Ohio | $452 - $5,650 | 3% |
| Wc Great West Casualty | $452 - $5,650 | 3% |
| Wc Guarantee Insurance | $452 - $5,650 | 3% |
| Wc Guard Insurance Company | $452 - $5,650 | 3% |
| Wc Hab | $452 - $5,650 | 3% |
| Wc Hartford | $452 - $5,650 | 3% |
| Wc Hastings | $452 - $5,650 | 3% |
| Wc Health Management | $452 - $5,650 | 3% |
| Wc Heritage Summit | $452 - $5,650 | 3% |
| Wc Hireright | $452 - $5,650 | 3% |
| Wc Horizon | $452 - $5,650 | 3% |
| Wc Icw Group | $452 - $5,650 | 3% |
| Wc Idaho State Ins Fund | $452 - $5,650 | 3% |
| Wc Intercare Insurance | $452 - $5,650 | 3% |
| Wc Intermountain | $452 - $5,650 | 3% |
| Wc Johns Eastern | $452 - $5,650 | 3% |
| Wc Kemberton | $452 - $5,650 | 3% |
| Wc Key Ins & Benefit Solutions | $452 - $5,650 | 3% |
| Wc Liberty Mutual | $452 - $5,650 | 3% |
| Wc Mac Risk Management | $452 - $5,650 | 3% |
| Wc Massachusetts | $452 - $5,650 | 3% |
| Wc Mdia | $452 - $5,650 | 3% |
| Wc Meadowbrook Claim | $452 - $5,650 | 3% |
| Wc Medical Administrators | $452 - $5,650 | 3% |
| Wc Meijers | $452 - $5,650 | 3% |
| Wc Memic | $452 - $5,650 | 3% |
| Wc Mercy Workcare | $452 - $5,650 | 3% |
| Wc Michigan | $452 - $5,650 | 3% |
| Wc Michigan Millers Mutual | $452 - $5,650 | 3% |
| Wc Mitchell Frankenmuth | $452 - $5,650 | 3% |
| Wc Mra | $452 - $5,650 | 3% |
| Wc Nationwide | $452 - $5,650 | 3% |
| Wc Nca Comp | $452 - $5,650 | 3% |
| Wc New York | $452 - $5,650 | 3% |
| Wc New York Special Funds | $452 - $5,650 | 3% |
| Wc North American Rishces | $452 - $5,650 | 3% |
| Wc Northeast Health | $452 - $5,650 | 3% |
| Wc Notre Dame | $452 - $5,650 | 3% |
| Wc Novanet | $452 - $5,650 | 3% |
| Wc Occ Health Allen | $452 - $5,650 | 3% |
| Wc Ohio Bureau | $452 - $5,650 | 3% |
| Wc One Call Medical | $452 - $5,650 | 3% |
| Wc Paradigm | $452 - $5,650 | 3% |
| Wc Peerless | $452 - $5,650 | 3% |
| Wc Pma | $452 - $5,650 | 3% |
| Wc Price Chopper | $452 - $5,650 | 3% |
| Wc Procura Management | $452 - $5,650 | 3% |
| Wc Qualcare | $452 - $5,650 | 3% |
| Wc Quiktrip | $452 - $5,650 | 3% |
| Wc Rev Claims | $452 - $5,650 | 3% |
| Wc Risico | $452 - $5,650 | 3% |
| Wc Rural Mutual | $452 - $5,650 | 3% |
| Wc Saif Oregon | $452 - $5,650 | 3% |
| Wc Secura | $452 - $5,650 | 3% |
| Wc Sedgwick | $452 - $5,650 | 3% |
| Wc Sentry | $452 - $5,650 | 3% |
| Wc Sheakley Unicomp | $452 - $5,650 | 3% |
| Wc Smile Lodge | $452 - $5,650 | 3% |
| Wc Society | $452 - $5,650 | 3% |
| Wc Srs | $452 - $5,650 | 3% |
| Wc Taconic (Mro) | $452 - $5,650 | 3% |
| Wc Taconic Farms | $452 - $5,650 | 3% |
| Wc Travelers | $452 - $5,650 | 3% |
| Wc Triad Group | $452 - $5,650 | 3% |
| Wc Tristar | $452 - $5,650 | 3% |
| Wc Troy Ny | $452 - $5,650 | 3% |
| Wc Tyson | $452 - $5,650 | 3% |
| Wc Unified Health Services | $452 - $5,650 | 3% |
| Wc United Heartland | $452 - $5,650 | 3% |
| Wc Us Dept Of Labor | $452 - $5,650 | 3% |
| Wc Walmart | $452 - $5,650 | 3% |
| Wc West Bend | $452 - $5,650 | 3% |
| Wc West Bend Mutual/Argent | $452 - $5,650 | 3% |
| Wc Winnebago Industries | $452 - $5,650 | 3% |
| Wc Yankee Trails | $452 - $5,650 | 3% |
| Wc York Risk | $452 - $5,650 | 3% |
| Wc Zenith | $452 - $5,650 | 3% |
| Wc Zurich | $452 - $5,650 | 3% |
| Albany County Correctional Facility | $697 - $1,046 | 5% |
| Amish Mennonite | $697 - $1,046 | 5% |
| Ascension St. Vincent Public Safety Medical | $697 - $1,046 | 5% |
| Bcccp-Michigan | $697 - $1,046 | 5% |
| Bccp | $697 - $1,046 | 5% |
| Bmc Healthnet | $697 - $1,046 | 5% |
| Breast Grant-Connecticut | $697 - $1,046 | 5% |
| Broward County Dept Of Health | $697 - $1,046 | 5% |
| California Health And Wellness | $697 - $1,046 | 5% |
| Can Community Health Inc | $697 - $1,046 | 5% |
| Cardinal Innovations Lme | $697 - $1,046 | 5% |
| Care Connections Of Northern Iowa | $697 - $1,046 | 5% |
| Care Oregon Ohp | $697 - $1,046 | 5% |
| Cencal Health Plan | $697 - $1,046 | 5% |
| Cenpatico | $697 - $1,046 | 5% |
| Chhuny | $697 - $1,046 | 5% |
| Childrens Comm Health Plan | $697 - $1,046 | 5% |
| Childrens Medical Services Title 19 | $697 - $1,046 | 5% |
| City Of Philadelphia | $697 - $1,046 | 5% |
| Cmh Allegan County | $697 - $1,046 | 5% |
| Cmh Ausable Valley | $697 - $1,046 | 5% |
| Cmh Barry County | $697 - $1,046 | 5% |
| Cmh Bay-Arenac County | $697 - $1,046 | 5% |
| Cmh Berrien County | $697 - $1,046 | 5% |
| Cmh Cass County | $697 - $1,046 | 5% |
| Cmh Central Mi County | $697 - $1,046 | 5% |
| Cmh Clinton-Eaton-Ingham County | $697 - $1,046 | 5% |
| Cmh Detroit Wayne Integrated Health Network | $697 - $1,046 | 5% |
| Cmh Genesee County | $697 - $1,046 | 5% |
| Cmh Ionia County | $697 - $1,046 | 5% |
| Cmh Jackson County/Lifeways | $697 - $1,046 | 5% |
| Cmh Kalamazoo | $697 - $1,046 | 5% |
| Cmh Kent County | $697 - $1,046 | 5% |
| Cmh Lenawee County | $697 - $1,046 | 5% |
| Cmh Livingston County | $697 - $1,046 | 5% |
| Cmh Macomb | $697 - $1,046 | 5% |
| Cmh Misc | $697 - $1,046 | 5% |
| Cmh Monroe County | $697 - $1,046 | 5% |
| Cmh Montcalm County | $697 - $1,046 | 5% |
| Cmh Muskegon County | $697 - $1,046 | 5% |
| Cmh Newaygo County | $697 - $1,046 | 5% |
| Cmh North Country | $697 - $1,046 | 5% |
| Cmh Northern Lakes County | $697 - $1,046 | 5% |
| Cmh Oakland County | $697 - $1,046 | 5% |
| Cmh Ottawa County | $697 - $1,046 | 5% |
| Cmh Van Buren County | $697 - $1,046 | 5% |
| Cmh Washtenaw County | $697 - $1,046 | 5% |
| Cmh Wayne County/Carelink | $697 - $1,046 | 5% |
| Cmh Wayne Cty/Com Liv Svcs | $697 - $1,046 | 5% |
| Cmh West Mi County | $697 - $1,046 | 5% |
| Community Benefit Health | $697 - $1,046 | 5% |
| Community Care Behavorial Health | $697 - $1,046 | 5% |
| Community Care Partners | $697 - $1,046 | 5% |
| Community Health Choice | $697 - $1,046 | 5% |
| Connections Csp | $697 - $1,046 | 5% |
| County Coroner | $697 - $1,046 | 5% |
| County Funding Generic | $697 - $1,046 | 5% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $697 - $1,046 | 5% |
| Dean Wi Badgercare | $697 - $1,046 | 5% |
| Delaware County Department Of Health | $697 - $1,046 | 5% |
| Delaware First Health | $697 - $1,046 | 5% |
| Delta Dental Nj | $697 - $1,046 | 5% |
| Dph Tb Program | $697 - $1,046 | 5% |
| Dscc | $697 - $1,046 | 5% |
| Eastpointe Lme | $697 - $1,046 | 5% |
| Family Health Network | $697 - $1,046 | 5% |
| Freedom First Healthcare | $697 - $1,046 | 5% |
| Fresno County Ccs | $697 - $1,046 | 5% |
| Ghc Scw Wi Badgercare | $697 - $1,046 | 5% |
| Harbor Health | $697 - $1,046 | 5% |
| Health Safety Net | $697 - $1,046 | 5% |
| Healthy Blue Ne | $697 - $1,046 | 5% |
| Hennepin Health | $697 - $1,046 | 5% |
| Id County Ada | $697 - $1,046 | 5% |
| Id County Canyon | $697 - $1,046 | 5% |
| Id County Cat Fund | $697 - $1,046 | 5% |
| Id County Other | $697 - $1,046 | 5% |
| Id County Payette | $697 - $1,046 | 5% |
| Idaho Dept Health And Wellfare | $697 - $1,046 | 5% |
| Idaho Womens Health Check | $697 - $1,046 | 5% |
| Indiana Breast Cervical Cancer | $697 - $1,046 | 5% |
| Inland Empire Health Plan | $697 - $1,046 | 5% |
| Intercommunity Health Ohp | $697 - $1,046 | 5% |
| Jai Medical System | $697 - $1,046 | 5% |
| Kern Family Health Plan | $697 - $1,046 | 5% |
| Keystone First | $697 - $1,046 | 5% |
| Keystone First Chip | $697 - $1,046 | 5% |
| La Care Health Plan | $697 - $1,046 | 5% |
| Lakeland Care Inc | $697 - $1,046 | 5% |
| Managed Health Services - Indiana | $697 - $1,046 | 5% |
| Maryland Breast & Cervical Program | $697 - $1,046 | 5% |
| Maryland Healthy Smiles - Scion Dental | $697 - $1,046 | 5% |
| Maryland Physicians Care | $697 - $1,046 | 5% |
| Massachusetts Behavioral Health Partnership | $697 - $1,046 | 5% |
| Mdwise | $697 - $1,046 | 5% |
| Medi-Cal | $697 - $1,046 | 5% |
| Medi-Cal Healthnet | $697 - $1,046 | 5% |
| Medstar Dc Healthy Family | $697 - $1,046 | 5% |
| Medstar Md Health Choice | $697 - $1,046 | 5% |
| Mo Home State Health Plan | $697 - $1,046 | 5% |
| Molina Centennial Care | $697 - $1,046 | 5% |
| Nascentia Health Options | $697 - $1,046 | 5% |
| New York Cancer Services Program | $697 - $1,046 | 5% |
| Nextlevel Health | $697 - $1,046 | 5% |
| Oregon Screenwise | $697 - $1,046 | 5% |
| Paramount Advantage | $697 - $1,046 | 5% |
| Parkland Community Health Plan | $697 - $1,046 | 5% |
| Partners Behavioral Lme | $697 - $1,046 | 5% |
| Peach State Healthplan | $697 - $1,046 | 5% |
| Philadelphia County Funding | $697 - $1,046 | 5% |
| Presbyterian Centennial Care | $697 - $1,046 | 5% |
| Prestige Health Choice | $697 - $1,046 | 5% |
| Priority Partners | $697 - $1,046 | 5% |
| Robert F Sing Program | $697 - $1,046 | 5% |
| Rx 340B Pass Along | $697 - $1,046 | 5% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $697 - $1,046 | 5% |
| Rx Medi-Cal | $697 - $1,046 | 5% |
| Rx Meridian Rx | $697 - $1,046 | 5% |
| Ryan White Florida Mssrp | $697 - $1,046 | 5% |
| Sandhills Center Lme | $697 - $1,046 | 5% |
| Screening For Life | $697 - $1,046 | 5% |
| St Joseph County Hlth Dpt | $697 - $1,046 | 5% |
| Sunshine State Health Plan | $697 - $1,046 | 5% |
| Superior Health | $697 - $1,046 | 5% |
| Tenncare | $697 - $1,046 | 5% |
| Texas Children'S Health Plan | $697 - $1,046 | 5% |
| Trillium Community Ohp | $697 - $1,046 | 5% |
| Tufts Health Public Plans | $697 - $1,046 | 5% |
| Vaya Health Lme | $697 - $1,046 | 5% |
| Washtenaw Health Plan | $697 - $1,046 | 5% |
| Wellsense Health Plan | $697 - $1,046 | 5% |
| Wi Womens Wellness | $697 - $1,046 | 5% |
| Iowa Total Care | $711 - $12,300 | 5% |
| Wellpoint | $718 - $1,077 | 5% |
| Asr Health Benefits | $6,596 | 50% |
| Christian Brother Services | $6,596 | 50% |
| Coventry | $6,596 | 50% |
| First Health | $6,596 | 50% |
| Luminare Health | $6,596 | 50% |
| Medical Mutual | $6,596 | 50% |
| Webtpa | $6,596 | 50% |
| Nova | $24,808 | 189% |