CMS Price Transparency Data
CT scan, abdomen and pelvis (no contrast)
Facility: Mercyone Des Moines Medical Center
Billing Code: 74176 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 74176
- Insurance Median: $79
- Cash Discount Price: $1,649
- vs. Medicare Baseline: 0.32x Medicare
The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at Mercyone Des Moines Medical Center is $79. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,649. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 0.32x the Medicare baseline. Located in 1111 6Th Ave, Des Moines, IA.
Cash / Self-Pay
$1,649
Average discount available for prompt cash payment at this facility.
Insurance Median
$79
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$243.77
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $243.77 (100%)
Cash / Self-Pay: $1,649 (676%)
Insurance Median: $79 (32%)
Cash: $1,649 (676% of Medicare)
Ins. Median: $79 (32% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $243.77 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 | $51 - $250 | 21% |
| Aetna | $55 - $1,627 | 23% |
| Wc Corvel | $72 | 30% |
| Align Senior Care | $75 | 31% |
| Ally Align Care Adv | $75 | 31% |
| American Health Advantage Of Idaho | $75 | 31% |
| Aurora Special Needs | $75 | 31% |
| Blue Care Network Advantage | $75 | 31% |
| Blue Cross Blue Shield | $75 - $244 | 31% |
| Blue Shield - De (Highmark) Medciare Advantage | $75 | 31% |
| Care Dimensions | $75 | 31% |
| Care Improvement Plus | $75 | 31% |
| Care Resources Pace | $75 | 31% |
| Careplus Health Plans | $75 | 31% |
| Cca - Zing Health | $75 | 31% |
| Cca Senior Care Options | $75 | 31% |
| Central Valley Medical Services Corp Pace | $75 | 31% |
| Champion Health Plan Mcr Advantage | $75 | 31% |
| Cigna | $75 - $2,813 | 31% |
| Clear Spring Health | $75 | 31% |
| Clover Health | $75 | 31% |
| Commonwealth Care Alliance | $75 | 31% |
| Community Pace At Home | $75 | 31% |
| Eddy Senior Care-Pace | $75 | 31% |
| Eddy Seniorcare Pace | $75 | 31% |
| Elementcare | $75 | 31% |
| Evercare | $75 | 31% |
| Everence | $75 | 31% |
| Gateway Health Plan | $75 | 31% |
| Genesys Pace Of Genesee County | $75 | 31% |
| Georgia Health Advantage | $75 | 31% |
| Gold Advantage | $75 | 31% |
| Gpa Croell Redi Mix | $75 | 31% |
| Health America Advantra | $75 | 31% |
| Highmark Health Options Dual Plan | $75 | 31% |
| Hope Select Pace | $75 | 31% |
| Horizon Nj Total Care | $75 | 31% |
| Hudson Headwaters Pace | $75 | 31% |
| Humana | $75 - $122 | 31% |
| Huron Valley Pace | $75 | 31% |
| Innovative Integrated Health Community Plans | $75 | 31% |
| Johns Hopkins Advantage Md | $75 | 31% |
| Lasso Healthcare Msa | $75 | 31% |
| Life St Marys Pace | $75 | 31% |
| Lifecircles Pace | $75 | 31% |
| Longevity Health Plan | $75 | 31% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $75 | 31% |
| Martins Point Generations Advantage | $75 | 31% |
| Mass General Brigham Mcr Adv | $75 | 31% |
| Medicare (plans) | $75 - $235 | 31% |
| Medipak Advantage | $75 | 31% |
| Mercy Life | $75 | 31% |
| Mercyone Cedar Valley | $75 | 31% |
| Meridian Complete | $75 | 31% |
| Michigan Complete Health | $75 | 31% |
| Nascentia Health Plus | $75 | 31% |
| New Centry Health Careplus | $75 | 31% |
| Osu Prime Care Advantage | $75 | 31% |
| Pace Cny | $75 | 31% |
| Pace Iowa Immanuel Pathways | $75 | 31% |
| Pace Of Southwest Michigan | $75 - $78 | 31% |
| Pace Southeast | $75 | 31% |
| Pace-Trinity Health | $75 | 31% |
| Peak Pace Solutions | $75 | 31% |
| Perennial Advantage | $75 | 31% |
| Preferred Care Partners | $75 | 31% |
| Presbyterian Senior Plan | $75 | 31% |
| Provider Partners Health Plan Of Illinois | $75 | 31% |
| Provider Partners Health Plan Of Indiana | $75 | 31% |
| Pruitthealth Premier | $75 | 31% |
| Reliance Community Care Partners Care Resources Pace | $75 | 31% |
| Rx Allwin | $75 | 31% |
| Rx Grane Grnmedd | $75 | 31% |
| Rx Retiree Rx Care | $75 | 31% |
| Scan Health Plan Mcr Ipa Meritage Oon | $75 | 31% |
| Secure Horizons Ma Pffs | $75 | 31% |
| Serenity Pace | $75 | 31% |
| Siouxland Pace | $75 | 31% |
| Solis Health Plans | $75 | 31% |
| Sunnyview-Pace Finance Dept | $75 | 31% |
| Texan Plus | $75 | 31% |
| The Health Plan | $75 | 31% |
| Thome Pace | $75 | 31% |
| Todays Options | $75 | 31% |
| Tribute Health Plans | $75 | 31% |
| Um Health Advantage | $75 | 31% |
| Union Health Service | $75 | 31% |
| UnitedHealthcare | $75 - $4,689 | 31% |
| Welbe Health | $75 | 31% |
| Wellmed | $75 | 31% |
| Champva | $76 | 31% |
| Tricare | $76 | 31% |
| Triwest Health Alliance | $76 | 31% |
| Us Family Health Plan | $76 | 31% |
| Veterans Administration | $76 | 31% |
| Veterans Eval Services | $76 | 31% |
| Albany County Correctional Facility | $78 | 32% |
| Ambetter / Centene | $78 - $387 | 32% |
| Amish Mennonite | $78 | 32% |
| Ascension St. Vincent Public Safety Medical | $78 | 32% |
| Bcccp-Michigan | $78 | 32% |
| Bccp | $78 | 32% |
| Bmc Healthnet | $78 | 32% |
| Breast Grant-Connecticut | $78 | 32% |
| Broward County Dept Of Health | $78 | 32% |
| California Health And Wellness | $78 | 32% |
| Can Community Health Inc | $78 | 32% |
| Cardinal Innovations Lme | $78 | 32% |
| Care Connections Of Northern Iowa | $78 | 32% |
| Care Oregon Ohp | $78 | 32% |
| Cencal Health Plan | $78 | 32% |
| Cenpatico | $78 | 32% |
| Chhuny | $78 | 32% |
| Childrens Comm Health Plan | $78 | 32% |
| Childrens Medical Services Title 19 | $78 | 32% |
| City Of Philadelphia | $78 | 32% |
| Cmh Allegan County | $78 | 32% |
| Cmh Ausable Valley | $78 | 32% |
| Cmh Barry County | $78 | 32% |
| Cmh Bay-Arenac County | $78 | 32% |
| Cmh Berrien County | $78 | 32% |
| Cmh Cass County | $78 | 32% |
| Cmh Central Mi County | $78 | 32% |
| Cmh Clinton-Eaton-Ingham County | $78 | 32% |
| Cmh Detroit Wayne Integrated Health Network | $78 | 32% |
| Cmh Genesee County | $78 | 32% |
| Cmh Ionia County | $78 | 32% |
| Cmh Jackson County/Lifeways | $78 | 32% |
| Cmh Kalamazoo | $78 | 32% |
| Cmh Kent County | $78 | 32% |
| Cmh Lenawee County | $78 | 32% |
| Cmh Livingston County | $78 | 32% |
| Cmh Macomb | $78 | 32% |
| Cmh Misc | $78 | 32% |
| Cmh Monroe County | $78 | 32% |
| Cmh Montcalm County | $78 | 32% |
| Cmh Muskegon County | $78 | 32% |
| Cmh Newaygo County | $78 | 32% |
| Cmh North Country | $78 | 32% |
| Cmh Northern Lakes County | $78 | 32% |
| Cmh Oakland County | $78 | 32% |
| Cmh Ottawa County | $78 | 32% |
| Cmh Van Buren County | $78 | 32% |
| Cmh Washtenaw County | $78 | 32% |
| Cmh Wayne County/Carelink | $78 | 32% |
| Cmh Wayne Cty/Com Liv Svcs | $78 | 32% |
| Cmh West Mi County | $78 | 32% |
| Community Benefit Health | $78 | 32% |
| Community Care Behavorial Health | $78 | 32% |
| Community Care Partners | $78 | 32% |
| Community Health Choice | $78 | 32% |
| Connections Csp | $78 | 32% |
| County Coroner | $78 | 32% |
| County Funding Generic | $78 | 32% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $78 | 32% |
| Dean Wi Badgercare | $78 | 32% |
| Delaware County Department Of Health | $78 | 32% |
| Delaware First Health | $78 | 32% |
| Delta Dental Nj | $78 | 32% |
| Dph Tb Program | $78 | 32% |
| Dscc | $78 | 32% |
| Eastpointe Lme | $78 | 32% |
| Family Health Network | $78 | 32% |
| Freedom First Healthcare | $78 | 32% |
| Fresno County Ccs | $78 | 32% |
| Ghc Scw Wi Badgercare | $78 | 32% |
| Harbor Health | $78 | 32% |
| Health Safety Net | $78 | 32% |
| Healthy Blue Ne | $78 | 32% |
| Hennepin Health | $78 | 32% |
| Id County Ada | $78 | 32% |
| Id County Canyon | $78 | 32% |
| Id County Cat Fund | $78 | 32% |
| Id County Other | $78 | 32% |
| Id County Payette | $78 | 32% |
| Idaho Dept Health And Wellfare | $78 | 32% |
| Idaho Womens Health Check | $78 | 32% |
| Indiana Breast Cervical Cancer | $78 | 32% |
| Inland Empire Health Plan | $78 | 32% |
| Intercommunity Health Ohp | $78 | 32% |
| Jai Medical System | $78 | 32% |
| Kern Family Health Plan | $78 | 32% |
| Keystone First | $78 | 32% |
| Keystone First Chip | $78 | 32% |
| La Care Health Plan | $78 | 32% |
| Lakeland Care Inc | $78 | 32% |
| Managed Health Services - Indiana | $78 | 32% |
| Maryland Breast & Cervical Program | $78 | 32% |
| Maryland Healthy Smiles - Scion Dental | $78 | 32% |
| Maryland Physicians Care | $78 | 32% |
| Massachusetts Behavioral Health Partnership | $78 | 32% |
| Mdwise | $78 | 32% |
| Medi-Cal | $78 | 32% |
| Medi-Cal Healthnet | $78 | 32% |
| Medstar Dc Healthy Family | $78 | 32% |
| Medstar Md Health Choice | $78 | 32% |
| Mo Home State Health Plan | $78 | 32% |
| Molina Centennial Care | $78 | 32% |
| Nascentia Health Options | $78 | 32% |
| New York Cancer Services Program | $78 | 32% |
| Nextlevel Health | $78 | 32% |
| Oregon Screenwise | $78 | 32% |
| Paramount Advantage | $78 | 32% |
| Parkland Community Health Plan | $78 | 32% |
| Partners Behavioral Lme | $78 | 32% |
| Peach State Healthplan | $78 | 32% |
| Philadelphia County Funding | $78 | 32% |
| Presbyterian Centennial Care | $78 | 32% |
| Prestige Health Choice | $78 | 32% |
| Priority Partners | $78 | 32% |
| Robert F Sing Program | $78 | 32% |
| Rx 340B Pass Along | $78 | 32% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $78 | 32% |
| Rx Medi-Cal | $78 | 32% |
| Rx Meridian Rx | $78 | 32% |
| Ryan White Florida Mssrp | $78 | 32% |
| Sandhills Center Lme | $78 | 32% |
| Screening For Life | $78 | 32% |
| St Joseph County Hlth Dpt | $78 | 32% |
| Sunshine State Health Plan | $78 | 32% |
| Superior Health | $78 | 32% |
| Tenncare | $78 | 32% |
| Texas Children'S Health Plan | $78 | 32% |
| Trillium Community Ohp | $78 | 32% |
| Tufts Health Public Plans | $78 | 32% |
| Vaya Health Lme | $78 | 32% |
| Washtenaw Health Plan | $78 | 32% |
| Wellsense Health Plan | $78 | 32% |
| Wi Womens Wellness | $78 | 32% |
| American Health Plan | $79 | 32% |
| Iowa Health Advantage | $79 | 32% |
| Iowa Total Care | $80 - $225 | 33% |
| Wellpoint | $80 | 33% |
| Stephenson Cty Health | $84 | 34% |
| Amish Hospital Aid | $101 - $307 | 41% |
| Amps | $103 | 42% |
| Avera | $117 | 48% |
| Newton Correctional Facility | $117 - $162 | 48% |
| Medical Associates | $127 - $942 | 52% |
| Sanford Health Plan | $128 | 53% |
| Oscar | $134 - $327 | 55% |
| Genex Wc | $135 - $188 | 55% |
| Centivo | $136 - $333 | 56% |
| Lucent Health | $137 - $1,627 | 56% |
| Ucare | $137 | 56% |
| Wc Align Network | $144 - $200 | 59% |
| Usa Managed Care | $148 - $3,986 | 61% |
| Quiktrip | $149 | 61% |
| Wc Praxis Health Network | $153 - $212 | 63% |
| Health Partners | $155 - $2,978 | 64% |
| Bcn Domestic | $157 | 64% |
| Blue Benefit Administrators Of Massachusetts | $157 - $244 | 64% |
| Blue Care Network | $157 - $244 | 64% |
| Blue Distinction Transplant | $157 - $244 | 64% |
| Blue Shield - Ca | $157 - $244 | 64% |
| Blue Shield - Id (Regence) | $157 - $244 | 64% |
| Blue Shield - Ny Highmark Northeastern | $157 - $244 | 64% |
| Blue Shield - Ny Highmark Western | $157 - $244 | 64% |
| Blue Shield - Pa (Highmark) | $157 - $244 | 64% |
| Blue Shield - Wa (Regence) | $157 - $244 | 64% |
| Health Choices | $157 - $942 | 64% |
| Kaiser Domestic | $157 | 64% |
| Pre-Employment | $157 | 64% |
| Wc Domestic | $157 | 64% |
| Wc Reny Company | $157 - $218 | 64% |
| Wc Velocity | $157 - $218 | 64% |
| Claimdoc | $159 - $463 | 65% |
| The Alliance | $160 | 66% |
| Auto Velocity | $162 - $225 | 66% |
| Health Smart | $162 - $225 | 66% |
| Meritain | $162 - $1,627 | 66% |
| Wc O'Hara Corp | $162 - $225 | 66% |
| Geha | $164 - $525 | 67% |
| Preferred One | $167 | 69% |
| Global Excel | $172 | 71% |
| Velocity | $179 | 73% |
| Allied Benefit Systems | $180 - $1,627 | 74% |
| Andrie Inc | $180 - $250 | 74% |
| Auxiant | $180 - $3,048 | 74% |
| East Greenbush Central School District | $180 - $250 | 74% |
| First Choice Health | $180 - $225 | 74% |
| Group Administrators | $180 - $225 | 74% |
| Healthsmart Workers Comp | $180 - $250 | 74% |
| Iowa Dept Of Public Health | $180 - $4,689 | 74% |
| Jag Source | $180 - $250 | 74% |
| Midlands | $180 - $3,048 | 74% |
| Midlands Choice | $180 - $3,048 | 74% |
| Multiplan | $180 - $250 | 74% |
| Nebraska Total Care | $180 - $250 | 74% |
| New York State Insurance Fund | $180 - $250 | 74% |
| Njm Insurance Group | $180 - $250 | 74% |
| Rx Heatlhcomp | $180 - $250 | 74% |
| Rx Restat | $180 - $250 | 74% |
| Rx Saif Opdp Wc | $180 - $250 | 74% |
| Rx Worker'S Comp | $180 - $250 | 74% |
| Wc Accident Fund | $180 - $250 | 74% |
| Wc Ace | $180 - $250 | 74% |
| Wc Acs Federal Employees | $180 - $250 | 74% |
| Wc Acuity | $180 - $250 | 74% |
| Wc Advantage | $180 - $250 | 74% |
| Wc Aegis | $180 - $250 | 74% |
| Wc Aig | $180 - $250 | 74% |
| Wc Aims | $180 - $250 | 74% |
| Wc Alaska National Ins | $180 - $250 | 74% |
| Wc Allied | $180 - $250 | 74% |
| Wc Am Trust N America | $180 - $250 | 74% |
| Wc American Claims Mgmt | $180 - $250 | 74% |
| Wc Amerisure | $180 - $250 | 74% |
| Wc Amtrust | $180 - $250 | 74% |
| Wc Asu Risk Mgt | $180 - $250 | 74% |
| Wc Benetech | $180 - $250 | 74% |
| Wc Berkley Admin | $180 - $250 | 74% |
| Wc Broadspire | $180 - $250 | 74% |
| Wc Broward County | $180 - $250 | 74% |
| Wc Bunch & Associates | $180 - $250 | 74% |
| Wc California State Comp Ins | $180 - $250 | 74% |
| Wc California State Ins Fund | $180 - $250 | 74% |
| Wc Capitol Area Health Consortium | $180 - $250 | 74% |
| Wc Ccmsi | $180 - $250 | 74% |
| Wc Chartis | $180 - $250 | 74% |
| Wc Chubb | $180 - $250 | 74% |
| Wc Cirma | $180 - $250 | 74% |
| Wc City Of Albany | $180 - $250 | 74% |
| Wc City Of Sioux City | $180 - $250 | 74% |
| Wc Claims Mgmt Inc | $180 - $250 | 74% |
| Wc Cna | $180 - $250 | 74% |
| Wc Comp One Admin C/O Manageability | $180 - $250 | 74% |
| Wc Compone Admin | $180 - $250 | 74% |
| Wc Ct Healthcare Trust | $180 - $250 | 74% |
| Wc Donegal Insurance Group | $180 - $250 | 74% |
| Wc Emc Insurance Company | $180 - $250 | 74% |
| Wc Employee Mutual | $180 - $250 | 74% |
| Wc Enablecomp | $180 - $250 | 74% |
| Wc Encore Health Network | $180 - $250 | 74% |
| Wc Erie | $180 - $250 | 74% |
| Wc Esis | $180 - $250 | 74% |
| Wc Evolutions | $180 - $250 | 74% |
| Wc Fcci | $180 - $250 | 74% |
| Wc Fed Ex | $180 - $250 | 74% |
| Wc Federal Black Lung | $180 - $250 | 74% |
| Wc Federated | $180 - $250 | 74% |
| Wc Finley Occupational Health | $180 - $250 | 74% |
| Wc First Agency/Occunet | $180 - $250 | 74% |
| Wc Ford Motor | $180 - $250 | 74% |
| Wc Fresno Unified Emp | $180 - $250 | 74% |
| Wc Gallagher Bassett | $180 - $250 | 74% |
| Wc General Motors | $180 - $250 | 74% |
| Wc Generic | $180 - $250 | 74% |
| Wc Genex Care For Ohio | $180 - $250 | 74% |
| Wc Great West Casualty | $180 - $250 | 74% |
| Wc Guarantee Insurance | $180 - $250 | 74% |
| Wc Guard Insurance Company | $180 - $250 | 74% |
| Wc Hab | $180 - $250 | 74% |
| Wc Hartford | $180 - $250 | 74% |
| Wc Hastings | $180 - $250 | 74% |
| Wc Health Management | $180 - $250 | 74% |
| Wc Heritage Summit | $180 - $250 | 74% |
| Wc Hireright | $180 - $250 | 74% |
| Wc Horizon | $180 - $250 | 74% |
| Wc Icw Group | $180 - $250 | 74% |
| Wc Idaho State Ins Fund | $180 - $250 | 74% |
| Wc Intercare Insurance | $180 - $250 | 74% |
| Wc Intermountain | $180 - $250 | 74% |
| Wc Johns Eastern | $180 - $250 | 74% |
| Wc Kemberton | $180 - $250 | 74% |
| Wc Key Ins & Benefit Solutions | $180 - $250 | 74% |
| Wc Liberty Mutual | $180 - $250 | 74% |
| Wc Mac Risk Management | $180 - $250 | 74% |
| Wc Massachusetts | $180 - $250 | 74% |
| Wc Mdia | $180 - $250 | 74% |
| Wc Meadowbrook Claim | $180 - $250 | 74% |
| Wc Medical Administrators | $180 - $250 | 74% |
| Wc Meijers | $180 - $250 | 74% |
| Wc Memic | $180 - $250 | 74% |
| Wc Mercy Workcare | $180 - $250 | 74% |
| Wc Michigan | $180 - $250 | 74% |
| Wc Michigan Millers Mutual | $180 - $250 | 74% |
| Wc Mitchell Frankenmuth | $180 - $250 | 74% |
| Wc Mra | $180 - $250 | 74% |
| Wc Nationwide | $180 - $250 | 74% |
| Wc Nca Comp | $180 - $250 | 74% |
| Wc New York | $180 - $250 | 74% |
| Wc New York Special Funds | $180 - $250 | 74% |
| Wc North American Rishces | $180 - $250 | 74% |
| Wc Northeast Health | $180 - $250 | 74% |
| Wc Notre Dame | $180 - $250 | 74% |
| Wc Novanet | $180 - $250 | 74% |
| Wc Occ Health Allen | $180 - $250 | 74% |
| Wc Ohio Bureau | $180 - $250 | 74% |
| Wc One Call Medical | $180 - $250 | 74% |
| Wc Paradigm | $180 - $250 | 74% |
| Wc Peerless | $180 - $250 | 74% |
| Wc Pma | $180 - $250 | 74% |
| Wc Price Chopper | $180 - $250 | 74% |
| Wc Procura Management | $180 - $250 | 74% |
| Wc Qualcare | $180 - $250 | 74% |
| Wc Quiktrip | $180 - $250 | 74% |
| Wc Rev Claims | $180 - $250 | 74% |
| Wc Risico | $180 - $250 | 74% |
| Wc Rural Mutual | $180 - $250 | 74% |
| Wc Saif Oregon | $180 - $250 | 74% |
| Wc Secura | $180 - $250 | 74% |
| Wc Sedgwick | $180 - $250 | 74% |
| Wc Sentry | $180 - $250 | 74% |
| Wc Sheakley Unicomp | $180 - $250 | 74% |
| Wc Smile Lodge | $180 - $250 | 74% |
| Wc Society | $180 - $250 | 74% |
| Wc Srs | $180 - $250 | 74% |
| Wc Taconic (Mro) | $180 - $250 | 74% |
| Wc Taconic Farms | $180 - $250 | 74% |
| Wc Travelers | $180 - $250 | 74% |
| Wc Triad Group | $180 - $250 | 74% |
| Wc Tristar | $180 - $250 | 74% |
| Wc Troy Ny | $180 - $250 | 74% |
| Wc Tyson | $180 - $250 | 74% |
| Wc Unified Health Services | $180 - $250 | 74% |
| Wc United Heartland | $180 - $250 | 74% |
| Wc Us Dept Of Labor | $180 - $250 | 74% |
| Wc Walmart | $180 - $250 | 74% |
| Wc West Bend | $180 - $250 | 74% |
| Wc West Bend Mutual/Argent | $180 - $250 | 74% |
| Wc Winnebago Industries | $180 - $250 | 74% |
| Wc Yankee Trails | $180 - $250 | 74% |
| Wc York Risk | $180 - $250 | 74% |
| Wc Zenith | $180 - $250 | 74% |
| Wc Zurich | $180 - $250 | 74% |
| Nova | $189 - $463 | 78% |
| 1199 National Benefit Fund | $1,627 | 667% |
| Asr Health Benefits | $1,627 | 667% |
| Christian Brother Services | $1,627 | 667% |
| Coventry | $1,627 | 667% |
| First Health | $1,627 | 667% |
| Luminare Health | $1,627 | 667% |
| Medical Mutual | $1,627 | 667% |
| Trustmark Small Business Benefits | $1,627 | 667% |
| Webtpa | $1,627 | 667% |
| Medica | $3,048 | 1250% |
| Crime Victim Assistance | $4,689 | 1924% |