CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: Mercyone Des Moines Medical Center
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $17
- Cash Discount Price: $259
- vs. Medicare Baseline: 0.08x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Mercyone Des Moines Medical Center is $17. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $259. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.08x the Medicare baseline. Located in 1111 6Th Ave, Des Moines, IA.
Cash / Self-Pay
$259
Average discount available for prompt cash payment at this facility.
Insurance Median
$17
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$223.72
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $223.72 (100%)
Cash / Self-Pay: $259 (116%)
Insurance Median: $17 (8%)
Cash: $259 (116% of Medicare)
Ins. Median: $17 (8% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $223.72 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 |
|---|---|---|
| Medicaid / KanCare | $6 - $357 | 3% |
| Aetna | $7 - $353 | 3% |
| Champva | $7 | 3% |
| Humana | $7 - $17 | 3% |
| Tricare | $7 | 3% |
| Triwest Health Alliance | $7 | 3% |
| Us Family Health Plan | $7 | 3% |
| Veterans Eval Services | $7 | 3% |
| Wc Corvel | $7 | 3% |
| Align Senior Care | $8 | 4% |
| Ally Align Care Adv | $8 | 4% |
| American Health Advantage Of Idaho | $8 | 4% |
| American Health Plan | $8 | 4% |
| Aurora Special Needs | $8 | 4% |
| Blue Care Network Advantage | $8 | 4% |
| Blue Cross Blue Shield | $8 - $381 | 4% |
| Blue Shield - De (Highmark) Medciare Advantage | $8 | 4% |
| Care Dimensions | $8 | 4% |
| Care Improvement Plus | $8 | 4% |
| Care Resources Pace | $8 | 4% |
| Careplus Health Plans | $8 | 4% |
| Cca - Zing Health | $8 | 4% |
| Cca Senior Care Options | $8 | 4% |
| Central Valley Medical Services Corp Pace | $8 | 4% |
| Champion Health Plan Mcr Advantage | $8 | 4% |
| Cigna | $8 - $239 | 4% |
| Clear Spring Health | $8 | 4% |
| Clover Health | $8 | 4% |
| Commonwealth Care Alliance | $8 | 4% |
| Community Pace At Home | $8 | 4% |
| Eddy Senior Care-Pace | $8 | 4% |
| Eddy Seniorcare Pace | $8 | 4% |
| Elementcare | $8 | 4% |
| Evercare | $8 | 4% |
| Everence | $8 | 4% |
| Gateway Health Plan | $8 | 4% |
| Genesys Pace Of Genesee County | $8 | 4% |
| Georgia Health Advantage | $8 | 4% |
| Gold Advantage | $8 | 4% |
| Gpa Croell Redi Mix | $8 | 4% |
| Health America Advantra | $8 | 4% |
| Highmark Health Options Dual Plan | $8 | 4% |
| Hope Select Pace | $8 | 4% |
| Horizon Nj Total Care | $8 | 4% |
| Hudson Headwaters Pace | $8 | 4% |
| Huron Valley Pace | $8 | 4% |
| Innovative Integrated Health Community Plans | $8 | 4% |
| Iowa Health Advantage | $8 | 4% |
| Johns Hopkins Advantage Md | $8 | 4% |
| Lasso Healthcare Msa | $8 | 4% |
| Life St Marys Pace | $8 | 4% |
| Lifecircles Pace | $8 | 4% |
| Longevity Health Plan | $8 | 4% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $8 | 4% |
| Martins Point Generations Advantage | $8 | 4% |
| Mass General Brigham Mcr Adv | $8 | 4% |
| Medicare (plans) | $8 - $368 | 4% |
| Medipak Advantage | $8 | 4% |
| Mercy Life | $8 | 4% |
| Mercyone Cedar Valley | $8 | 4% |
| Meridian Complete | $8 | 4% |
| Michigan Complete Health | $8 | 4% |
| Nascentia Health Plus | $8 | 4% |
| New Centry Health Careplus | $8 | 4% |
| Osu Prime Care Advantage | $8 | 4% |
| Pace Cny | $8 | 4% |
| Pace Iowa Immanuel Pathways | $8 | 4% |
| Pace Of Southwest Michigan | $8 - $17 | 4% |
| Pace Southeast | $8 | 4% |
| Pace-Trinity Health | $8 | 4% |
| Peak Pace Solutions | $8 | 4% |
| Perennial Advantage | $8 | 4% |
| Preferred Care Partners | $8 | 4% |
| Presbyterian Senior Plan | $8 | 4% |
| Provider Partners Health Plan Of Illinois | $8 | 4% |
| Provider Partners Health Plan Of Indiana | $8 | 4% |
| Pruitthealth Premier | $8 | 4% |
| Reliance Community Care Partners Care Resources Pace | $8 | 4% |
| Rx Allwin | $8 | 4% |
| Rx Grane Grnmedd | $8 | 4% |
| Rx Retiree Rx Care | $8 | 4% |
| Scan Health Plan Mcr Ipa Meritage Oon | $8 | 4% |
| Secure Horizons Ma Pffs | $8 | 4% |
| Serenity Pace | $8 | 4% |
| Siouxland Pace | $8 | 4% |
| Solis Health Plans | $8 | 4% |
| Sunnyview-Pace Finance Dept | $8 | 4% |
| Texan Plus | $8 | 4% |
| The Health Plan | $8 | 4% |
| Thome Pace | $8 | 4% |
| Todays Options | $8 | 4% |
| Tribute Health Plans | $8 | 4% |
| Um Health Advantage | $8 | 4% |
| Union Health Service | $8 | 4% |
| UnitedHealthcare | $8 - $399 | 4% |
| Veterans Administration | $8 | 4% |
| Welbe Health | $8 | 4% |
| Wellmed | $8 | 4% |
| Stephenson Cty Health | $9 | 4% |
| Amish Hospital Aid | $10 - $479 | 4% |
| Amps | $10 | 4% |
| Ambetter / Centene | $13 - $606 | 6% |
| Avera | $13 | 6% |
| Medical Associates | $13 - $80 | 6% |
| Lucent Health | $14 - $138 | 6% |
| Sanford Health Plan | $14 | 6% |
| Bcn Domestic | $15 | 7% |
| Blue Benefit Administrators Of Massachusetts | $15 - $381 | 7% |
| Blue Care Network | $15 - $381 | 7% |
| Blue Distinction Transplant | $15 - $381 | 7% |
| Blue Shield - Ca | $15 - $381 | 7% |
| Blue Shield - Id (Regence) | $15 - $381 | 7% |
| Blue Shield - Ny Highmark Northeastern | $15 - $381 | 7% |
| Blue Shield - Ny Highmark Western | $15 - $381 | 7% |
| Blue Shield - Pa (Highmark) | $15 - $381 | 7% |
| Blue Shield - Wa (Regence) | $15 - $381 | 7% |
| Centivo | $15 - $520 | 7% |
| Health Choices | $15 - $80 | 7% |
| Kaiser Domestic | $15 | 7% |
| Oscar | $15 - $512 | 7% |
| Pre-Employment | $15 | 7% |
| Quiktrip | $15 | 7% |
| Ucare | $15 | 7% |
| Usa Managed Care | $15 - $339 | 7% |
| Wc Domestic | $15 | 7% |
| Claimdoc | $16 - $724 | 7% |
| Health Partners | $16 - $253 | 7% |
| The Alliance | $16 | 7% |
| Albany County Correctional Facility | $17 | 8% |
| Amish Mennonite | $17 | 8% |
| Ascension St. Vincent Public Safety Medical | $17 | 8% |
| Bcccp-Michigan | $17 | 8% |
| Bccp | $17 | 8% |
| Bmc Healthnet | $17 | 8% |
| Breast Grant-Connecticut | $17 | 8% |
| Broward County Dept Of Health | $17 | 8% |
| California Health And Wellness | $17 | 8% |
| Can Community Health Inc | $17 | 8% |
| Cardinal Innovations Lme | $17 | 8% |
| Care Connections Of Northern Iowa | $17 | 8% |
| Care Oregon Ohp | $17 | 8% |
| Cencal Health Plan | $17 | 8% |
| Cenpatico | $17 | 8% |
| Chhuny | $17 | 8% |
| Childrens Comm Health Plan | $17 | 8% |
| Childrens Medical Services Title 19 | $17 | 8% |
| City Of Philadelphia | $17 | 8% |
| Cmh Allegan County | $17 | 8% |
| Cmh Ausable Valley | $17 | 8% |
| Cmh Barry County | $17 | 8% |
| Cmh Bay-Arenac County | $17 | 8% |
| Cmh Berrien County | $17 | 8% |
| Cmh Cass County | $17 | 8% |
| Cmh Central Mi County | $17 | 8% |
| Cmh Clinton-Eaton-Ingham County | $17 | 8% |
| Cmh Detroit Wayne Integrated Health Network | $17 | 8% |
| Cmh Genesee County | $17 | 8% |
| Cmh Ionia County | $17 | 8% |
| Cmh Jackson County/Lifeways | $17 | 8% |
| Cmh Kalamazoo | $17 | 8% |
| Cmh Kent County | $17 | 8% |
| Cmh Lenawee County | $17 | 8% |
| Cmh Livingston County | $17 | 8% |
| Cmh Macomb | $17 | 8% |
| Cmh Misc | $17 | 8% |
| Cmh Monroe County | $17 | 8% |
| Cmh Montcalm County | $17 | 8% |
| Cmh Muskegon County | $17 | 8% |
| Cmh Newaygo County | $17 | 8% |
| Cmh North Country | $17 | 8% |
| Cmh Northern Lakes County | $17 | 8% |
| Cmh Oakland County | $17 | 8% |
| Cmh Ottawa County | $17 | 8% |
| Cmh Van Buren County | $17 | 8% |
| Cmh Washtenaw County | $17 | 8% |
| Cmh Wayne County/Carelink | $17 | 8% |
| Cmh Wayne Cty/Com Liv Svcs | $17 | 8% |
| Cmh West Mi County | $17 | 8% |
| Community Benefit Health | $17 | 8% |
| Community Care Behavorial Health | $17 | 8% |
| Community Care Partners | $17 | 8% |
| Community Health Choice | $17 | 8% |
| Connections Csp | $17 | 8% |
| County Coroner | $17 | 8% |
| County Funding Generic | $17 | 8% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $17 | 8% |
| Dean Wi Badgercare | $17 | 8% |
| Delaware County Department Of Health | $17 | 8% |
| Delaware First Health | $17 | 8% |
| Delta Dental Nj | $17 | 8% |
| Dph Tb Program | $17 | 8% |
| Dscc | $17 | 8% |
| Eastpointe Lme | $17 | 8% |
| Family Health Network | $17 | 8% |
| Freedom First Healthcare | $17 | 8% |
| Fresno County Ccs | $17 | 8% |
| Ghc Scw Wi Badgercare | $17 | 8% |
| Harbor Health | $17 | 8% |
| Health Safety Net | $17 | 8% |
| Healthy Blue Ne | $17 | 8% |
| Hennepin Health | $17 | 8% |
| Id County Ada | $17 | 8% |
| Id County Canyon | $17 | 8% |
| Id County Cat Fund | $17 | 8% |
| Id County Other | $17 | 8% |
| Id County Payette | $17 | 8% |
| Idaho Dept Health And Wellfare | $17 | 8% |
| Idaho Womens Health Check | $17 | 8% |
| Indiana Breast Cervical Cancer | $17 | 8% |
| Inland Empire Health Plan | $17 | 8% |
| Intercommunity Health Ohp | $17 | 8% |
| Jai Medical System | $17 | 8% |
| Kern Family Health Plan | $17 | 8% |
| Keystone First | $17 | 8% |
| Keystone First Chip | $17 | 8% |
| La Care Health Plan | $17 | 8% |
| Lakeland Care Inc | $17 | 8% |
| Managed Health Services - Indiana | $17 | 8% |
| Maryland Breast & Cervical Program | $17 | 8% |
| Maryland Healthy Smiles - Scion Dental | $17 | 8% |
| Maryland Physicians Care | $17 | 8% |
| Massachusetts Behavioral Health Partnership | $17 | 8% |
| Mdwise | $17 | 8% |
| Medi-Cal | $17 | 8% |
| Medi-Cal Healthnet | $17 | 8% |
| Medstar Dc Healthy Family | $17 | 8% |
| Medstar Md Health Choice | $17 | 8% |
| Mo Home State Health Plan | $17 | 8% |
| Molina Centennial Care | $17 | 8% |
| Nascentia Health Options | $17 | 8% |
| New York Cancer Services Program | $17 | 8% |
| Nextlevel Health | $17 | 8% |
| Oregon Screenwise | $17 | 8% |
| Paramount Advantage | $17 | 8% |
| Parkland Community Health Plan | $17 | 8% |
| Partners Behavioral Lme | $17 | 8% |
| Peach State Healthplan | $17 | 8% |
| Philadelphia County Funding | $17 | 8% |
| Presbyterian Centennial Care | $17 | 8% |
| Prestige Health Choice | $17 | 8% |
| Priority Partners | $17 | 8% |
| Robert F Sing Program | $17 | 8% |
| Rx 340B Pass Along | $17 | 8% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $17 | 8% |
| Rx Medi-Cal | $17 | 8% |
| Rx Meridian Rx | $17 | 8% |
| Ryan White Florida Mssrp | $17 | 8% |
| Sandhills Center Lme | $17 | 8% |
| Screening For Life | $17 | 8% |
| St Joseph County Hlth Dpt | $17 | 8% |
| Sunshine State Health Plan | $17 | 8% |
| Superior Health | $17 | 8% |
| Tenncare | $17 | 8% |
| Texas Children'S Health Plan | $17 | 8% |
| Trillium Community Ohp | $17 | 8% |
| Tufts Health Public Plans | $17 | 8% |
| Vaya Health Lme | $17 | 8% |
| Washtenaw Health Plan | $17 | 8% |
| Wellsense Health Plan | $17 | 8% |
| Wi Womens Wellness | $17 | 8% |
| Global Excel | $18 | 8% |
| Iowa Total Care | $18 - $352 | 8% |
| Velocity | $18 | 8% |
| Wellpoint | $18 | 8% |
| Meritain | $23 - $138 | 10% |
| Allied Benefit Systems | $24 - $138 | 11% |
| Auxiant | $24 - $259 | 11% |
| First Choice Health | $24 | 11% |
| Group Administrators | $24 | 11% |
| Midlands | $24 - $259 | 11% |
| Midlands Choice | $24 - $259 | 11% |
| Multiplan | $26 | 12% |
| Preferred One | $28 | 13% |
| Newton Correctional Facility | $31 - $44 | 14% |
| Genex Wc | $36 - $51 | 16% |
| Wc Align Network | $38 - $54 | 17% |
| Wc Praxis Health Network | $40 - $58 | 18% |
| Wc Reny Company | $41 - $59 | 18% |
| Wc Velocity | $41 - $59 | 18% |
| Auto Velocity | $43 - $61 | 19% |
| Health Smart | $43 - $61 | 19% |
| Wc O'Hara Corp | $43 - $61 | 19% |
| Geha | $44 - $189 | 20% |
| Andrie Inc | $47 - $68 | 21% |
| East Greenbush Central School District | $47 - $68 | 21% |
| Healthsmart Workers Comp | $47 - $68 | 21% |
| Iowa Dept Of Public Health | $47 - $399 | 21% |
| Jag Source | $47 - $68 | 21% |
| Nebraska Total Care | $47 - $68 | 21% |
| New York State Insurance Fund | $47 - $68 | 21% |
| Njm Insurance Group | $47 - $68 | 21% |
| Rx Heatlhcomp | $47 - $68 | 21% |
| Rx Restat | $47 - $68 | 21% |
| Rx Saif Opdp Wc | $47 - $68 | 21% |
| Rx Worker'S Comp | $47 - $68 | 21% |
| Wc Accident Fund | $47 - $68 | 21% |
| Wc Ace | $47 - $68 | 21% |
| Wc Acs Federal Employees | $47 - $68 | 21% |
| Wc Acuity | $47 - $68 | 21% |
| Wc Advantage | $47 - $68 | 21% |
| Wc Aegis | $47 - $68 | 21% |
| Wc Aig | $47 - $68 | 21% |
| Wc Aims | $47 - $68 | 21% |
| Wc Alaska National Ins | $47 - $68 | 21% |
| Wc Allied | $47 - $68 | 21% |
| Wc Am Trust N America | $47 - $68 | 21% |
| Wc American Claims Mgmt | $47 - $68 | 21% |
| Wc Amerisure | $47 - $68 | 21% |
| Wc Amtrust | $47 - $68 | 21% |
| Wc Asu Risk Mgt | $47 - $68 | 21% |
| Wc Benetech | $47 - $68 | 21% |
| Wc Berkley Admin | $47 - $68 | 21% |
| Wc Broadspire | $47 - $68 | 21% |
| Wc Broward County | $47 - $68 | 21% |
| Wc Bunch & Associates | $47 - $68 | 21% |
| Wc California State Comp Ins | $47 - $68 | 21% |
| Wc California State Ins Fund | $47 - $68 | 21% |
| Wc Capitol Area Health Consortium | $47 - $68 | 21% |
| Wc Ccmsi | $47 - $68 | 21% |
| Wc Chartis | $47 - $68 | 21% |
| Wc Chubb | $47 - $68 | 21% |
| Wc Cirma | $47 - $68 | 21% |
| Wc City Of Albany | $47 - $68 | 21% |
| Wc City Of Sioux City | $47 - $68 | 21% |
| Wc Claims Mgmt Inc | $47 - $68 | 21% |
| Wc Cna | $47 - $68 | 21% |
| Wc Comp One Admin C/O Manageability | $47 - $68 | 21% |
| Wc Compone Admin | $47 - $68 | 21% |
| Wc Ct Healthcare Trust | $47 - $68 | 21% |
| Wc Donegal Insurance Group | $47 - $68 | 21% |
| Wc Emc Insurance Company | $47 - $68 | 21% |
| Wc Employee Mutual | $47 - $68 | 21% |
| Wc Enablecomp | $47 - $68 | 21% |
| Wc Encore Health Network | $47 - $68 | 21% |
| Wc Erie | $47 - $68 | 21% |
| Wc Esis | $47 - $68 | 21% |
| Wc Evolutions | $47 - $68 | 21% |
| Wc Fcci | $47 - $68 | 21% |
| Wc Fed Ex | $47 - $68 | 21% |
| Wc Federal Black Lung | $47 - $68 | 21% |
| Wc Federated | $47 - $68 | 21% |
| Wc Finley Occupational Health | $47 - $68 | 21% |
| Wc First Agency/Occunet | $47 - $68 | 21% |
| Wc Ford Motor | $47 - $68 | 21% |
| Wc Fresno Unified Emp | $47 - $68 | 21% |
| Wc Gallagher Bassett | $47 - $68 | 21% |
| Wc General Motors | $47 - $68 | 21% |
| Wc Generic | $47 - $68 | 21% |
| Wc Genex Care For Ohio | $47 - $68 | 21% |
| Wc Great West Casualty | $47 - $68 | 21% |
| Wc Guarantee Insurance | $47 - $68 | 21% |
| Wc Guard Insurance Company | $47 - $68 | 21% |
| Wc Hab | $47 - $68 | 21% |
| Wc Hartford | $47 - $68 | 21% |
| Wc Hastings | $47 - $68 | 21% |
| Wc Health Management | $47 - $68 | 21% |
| Wc Heritage Summit | $47 - $68 | 21% |
| Wc Hireright | $47 - $68 | 21% |
| Wc Horizon | $47 - $68 | 21% |
| Wc Icw Group | $47 - $68 | 21% |
| Wc Idaho State Ins Fund | $47 - $68 | 21% |
| Wc Intercare Insurance | $47 - $68 | 21% |
| Wc Intermountain | $47 - $68 | 21% |
| Wc Johns Eastern | $47 - $68 | 21% |
| Wc Kemberton | $47 - $68 | 21% |
| Wc Key Ins & Benefit Solutions | $47 - $68 | 21% |
| Wc Liberty Mutual | $47 - $68 | 21% |
| Wc Mac Risk Management | $47 - $68 | 21% |
| Wc Massachusetts | $47 - $68 | 21% |
| Wc Mdia | $47 - $68 | 21% |
| Wc Meadowbrook Claim | $47 - $68 | 21% |
| Wc Medical Administrators | $47 - $68 | 21% |
| Wc Meijers | $47 - $68 | 21% |
| Wc Memic | $47 - $68 | 21% |
| Wc Mercy Workcare | $47 - $68 | 21% |
| Wc Michigan | $47 - $68 | 21% |
| Wc Michigan Millers Mutual | $47 - $68 | 21% |
| Wc Mitchell Frankenmuth | $47 - $68 | 21% |
| Wc Mra | $47 - $68 | 21% |
| Wc Nationwide | $47 - $68 | 21% |
| Wc Nca Comp | $47 - $68 | 21% |
| Wc New York | $47 - $68 | 21% |
| Wc New York Special Funds | $47 - $68 | 21% |
| Wc North American Rishces | $47 - $68 | 21% |
| Wc Northeast Health | $47 - $68 | 21% |
| Wc Notre Dame | $47 - $68 | 21% |
| Wc Novanet | $47 - $68 | 21% |
| Wc Occ Health Allen | $47 - $68 | 21% |
| Wc Ohio Bureau | $47 - $68 | 21% |
| Wc One Call Medical | $47 - $68 | 21% |
| Wc Paradigm | $47 - $68 | 21% |
| Wc Peerless | $47 - $68 | 21% |
| Wc Pma | $47 - $68 | 21% |
| Wc Price Chopper | $47 - $68 | 21% |
| Wc Procura Management | $47 - $68 | 21% |
| Wc Qualcare | $47 - $68 | 21% |
| Wc Quiktrip | $47 - $68 | 21% |
| Wc Rev Claims | $47 - $68 | 21% |
| Wc Risico | $47 - $68 | 21% |
| Wc Rural Mutual | $47 - $68 | 21% |
| Wc Saif Oregon | $47 - $68 | 21% |
| Wc Secura | $47 - $68 | 21% |
| Wc Sedgwick | $47 - $68 | 21% |
| Wc Sentry | $47 - $68 | 21% |
| Wc Sheakley Unicomp | $47 - $68 | 21% |
| Wc Smile Lodge | $47 - $68 | 21% |
| Wc Society | $47 - $68 | 21% |
| Wc Srs | $47 - $68 | 21% |
| Wc Taconic (Mro) | $47 - $68 | 21% |
| Wc Taconic Farms | $47 - $68 | 21% |
| Wc Travelers | $47 - $68 | 21% |
| Wc Triad Group | $47 - $68 | 21% |
| Wc Tristar | $47 - $68 | 21% |
| Wc Troy Ny | $47 - $68 | 21% |
| Wc Tyson | $47 - $68 | 21% |
| Wc Unified Health Services | $47 - $68 | 21% |
| Wc United Heartland | $47 - $68 | 21% |
| Wc Us Dept Of Labor | $47 - $68 | 21% |
| Wc Walmart | $47 - $68 | 21% |
| Wc West Bend | $47 - $68 | 21% |
| Wc West Bend Mutual/Argent | $47 - $68 | 21% |
| Wc Winnebago Industries | $47 - $68 | 21% |
| Wc Yankee Trails | $47 - $68 | 21% |
| Wc York Risk | $47 - $68 | 21% |
| Wc Zenith | $47 - $68 | 21% |
| Wc Zurich | $47 - $68 | 21% |
| 1199 National Benefit Fund | $138 | 62% |
| Asr Health Benefits | $138 | 62% |
| Christian Brother Services | $138 | 62% |
| Coventry | $138 | 62% |
| First Health | $138 | 62% |
| Luminare Health | $138 | 62% |
| Medical Mutual | $138 | 62% |
| Trustmark Small Business Benefits | $138 | 62% |
| Webtpa | $138 | 62% |
| Medica | $259 | 116% |
| Crime Victim Assistance | $399 | 178% |
| Nova | $425 - $724 | 190% |