CMS Price Transparency Data
X-ray, foot
Facility: Mercyone Centerville Medical Center
Billing Code: 73630 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 73630
- Insurance Median: $29
- Cash Discount Price: $85
- vs. Medicare Baseline: 0.33x Medicare
The contracted insurance negotiated median rate for a X-ray, foot at Mercyone Centerville Medical Center is $29. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $85. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 0.33x the Medicare baseline. Located in One St Joseph's Drive, Centerville, IA.
Cash / Self-Pay
$85
Average discount available for prompt cash payment at this facility.
Insurance Median
$29
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$88.91
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $88.91 (100%)
Cash / Self-Pay: $85 (96%)
Insurance Median: $29 (33%)
Cash: $85 (96% of Medicare)
Ins. Median: $29 (33% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $88.91 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.
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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 | $5 - $147 | 6% |
| Iowa Total Care | $6 - $144 | 7% |
| Medicare (plans) | $6 - $157 | 7% |
| Aetna | $7 - $489 | 8% |
| Align Senior Care | $7 - $51 | 8% |
| Ally Align Care Adv | $7 - $51 | 8% |
| American Health Advantage Of Idaho | $7 - $51 | 8% |
| Aurora Special Needs | $7 - $51 | 8% |
| Blue Care Network Advantage | $7 - $51 | 8% |
| Blue Cross Blue Shield | $7 - $150 | 8% |
| Blue Shield - De (Highmark) Medciare Advantage | $7 - $51 | 8% |
| Care Dimensions | $7 - $51 | 8% |
| Care Improvement Plus | $7 - $51 | 8% |
| Care Resources Pace | $7 - $51 | 8% |
| Careplus Health Plans | $7 - $51 | 8% |
| Cca - Zing Health | $7 - $51 | 8% |
| Cca Senior Care Options | $7 - $51 | 8% |
| Central Valley Medical Services Corp Pace | $7 - $51 | 8% |
| Champion Health Plan Mcr Advantage | $7 - $51 | 8% |
| Champva | $7 - $37 | 8% |
| Cigna | $7 - $512 | 8% |
| Clear Spring Health | $7 - $51 | 8% |
| Clover Health | $7 - $51 | 8% |
| Commonwealth Care Alliance | $7 - $51 | 8% |
| Community Pace At Home | $7 - $51 | 8% |
| Eddy Senior Care-Pace | $7 - $51 | 8% |
| Eddy Seniorcare Pace | $7 - $51 | 8% |
| Elementcare | $7 - $51 | 8% |
| Evercare | $7 - $51 | 8% |
| Everence | $7 - $51 | 8% |
| Gateway Health Plan | $7 - $51 | 8% |
| Genesys Pace Of Genesee County | $7 - $51 | 8% |
| Georgia Health Advantage | $7 - $51 | 8% |
| Gold Advantage | $7 - $51 | 8% |
| Gpa Croell Redi Mix | $7 - $51 | 8% |
| Health America Advantra | $7 - $51 | 8% |
| Highmark Health Options Dual Plan | $7 - $51 | 8% |
| Hope Select Pace | $7 - $51 | 8% |
| Horizon Nj Total Care | $7 - $51 | 8% |
| Hudson Headwaters Pace | $7 - $51 | 8% |
| Humana | $7 - $84 | 8% |
| Huron Valley Pace | $7 - $51 | 8% |
| Innovative Integrated Health Community Plans | $7 - $51 | 8% |
| Johns Hopkins Advantage Md | $7 - $51 | 8% |
| Lasso Healthcare Msa | $7 - $51 | 8% |
| Life St Marys Pace | $7 - $51 | 8% |
| Lifecircles Pace | $7 - $51 | 8% |
| Longevity Health Plan | $7 - $51 | 8% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $7 - $51 | 8% |
| Martins Point Generations Advantage | $7 - $51 | 8% |
| Mass General Brigham Mcr Adv | $7 - $51 | 8% |
| Medipak Advantage | $7 - $51 | 8% |
| Mercy Life | $7 - $51 | 8% |
| Mercyone Cedar Valley | $7 - $51 | 8% |
| Meridian Complete | $7 - $51 | 8% |
| Michigan Complete Health | $7 - $51 | 8% |
| Nascentia Health Plus | $7 - $51 | 8% |
| New Centry Health Careplus | $7 - $51 | 8% |
| Osu Prime Care Advantage | $7 - $51 | 8% |
| Pace Cny | $7 - $51 | 8% |
| Pace Iowa Immanuel Pathways | $7 - $51 | 8% |
| Pace Of Southwest Michigan | $7 - $51 | 8% |
| Pace Southeast | $7 - $51 | 8% |
| Pace-Trinity Health | $7 - $51 | 8% |
| Peak Pace Solutions | $7 - $51 | 8% |
| Perennial Advantage | $7 - $51 | 8% |
| Preferred Care Partners | $7 - $51 | 8% |
| Presbyterian Senior Plan | $7 - $51 | 8% |
| Provider Partners Health Plan Of Illinois | $7 - $51 | 8% |
| Provider Partners Health Plan Of Indiana | $7 - $51 | 8% |
| Pruitthealth Premier | $7 - $51 | 8% |
| Reliance Community Care Partners Care Resources Pace | $7 - $51 | 8% |
| Rx Allwin | $7 - $51 | 8% |
| Rx Grane Grnmedd | $7 - $51 | 8% |
| Rx Retiree Rx Care | $7 - $51 | 8% |
| Scan Health Plan Mcr Ipa Meritage Oon | $7 - $51 | 8% |
| Secure Horizons Ma Pffs | $7 - $51 | 8% |
| Serenity Pace | $7 - $51 | 8% |
| Siouxland Pace | $7 - $51 | 8% |
| Solis Health Plans | $7 - $51 | 8% |
| Sunnyview-Pace Finance Dept | $7 - $51 | 8% |
| Texan Plus | $7 - $51 | 8% |
| The Health Plan | $7 - $51 | 8% |
| Thome Pace | $7 - $51 | 8% |
| Todays Options | $7 - $51 | 8% |
| Tribute Health Plans | $7 - $51 | 8% |
| Tricare | $7 - $37 | 8% |
| Triwest Health Alliance | $7 - $37 | 8% |
| Um Health Advantage | $7 - $51 | 8% |
| Union Health Service | $7 - $51 | 8% |
| UnitedHealthcare | $7 - $522 | 8% |
| Us Family Health Plan | $7 - $37 | 8% |
| Veterans Eval Services | $7 - $37 | 8% |
| Wc Corvel | $7 - $50 | 8% |
| Welbe Health | $7 - $51 | 8% |
| Wellmed | $7 - $51 | 8% |
| Albany County Correctional Facility | $8 - $27 | 9% |
| Ambetter / Centene | $8 - $254 | 9% |
| American Health Plan | $8 - $54 | 9% |
| Amish Mennonite | $8 - $27 | 9% |
| Ascension St. Vincent Public Safety Medical | $8 - $27 | 9% |
| Bcccp-Michigan | $8 - $27 | 9% |
| Bccp | $8 - $27 | 9% |
| Bmc Healthnet | $8 - $27 | 9% |
| Breast Grant-Connecticut | $8 - $27 | 9% |
| Broward County Dept Of Health | $8 - $27 | 9% |
| California Health And Wellness | $8 - $27 | 9% |
| Can Community Health Inc | $8 - $27 | 9% |
| Cardinal Innovations Lme | $8 - $27 | 9% |
| Care Connections Of Northern Iowa | $8 - $27 | 9% |
| Care Oregon Ohp | $8 - $27 | 9% |
| Cencal Health Plan | $8 - $27 | 9% |
| Cenpatico | $8 - $27 | 9% |
| Chhuny | $8 - $27 | 9% |
| Childrens Comm Health Plan | $8 - $27 | 9% |
| Childrens Medical Services Title 19 | $8 - $27 | 9% |
| City Of Philadelphia | $8 - $27 | 9% |
| Cmh Allegan County | $8 - $27 | 9% |
| Cmh Ausable Valley | $8 - $27 | 9% |
| Cmh Barry County | $8 - $27 | 9% |
| Cmh Bay-Arenac County | $8 - $27 | 9% |
| Cmh Berrien County | $8 - $27 | 9% |
| Cmh Cass County | $8 - $27 | 9% |
| Cmh Central Mi County | $8 - $27 | 9% |
| Cmh Clinton-Eaton-Ingham County | $8 - $27 | 9% |
| Cmh Detroit Wayne Integrated Health Network | $8 - $27 | 9% |
| Cmh Genesee County | $8 - $27 | 9% |
| Cmh Ionia County | $8 - $27 | 9% |
| Cmh Jackson County/Lifeways | $8 - $27 | 9% |
| Cmh Kalamazoo | $8 - $27 | 9% |
| Cmh Kent County | $8 - $27 | 9% |
| Cmh Lenawee County | $8 - $27 | 9% |
| Cmh Livingston County | $8 - $27 | 9% |
| Cmh Macomb | $8 - $27 | 9% |
| Cmh Misc | $8 - $27 | 9% |
| Cmh Monroe County | $8 - $27 | 9% |
| Cmh Montcalm County | $8 - $27 | 9% |
| Cmh Muskegon County | $8 - $27 | 9% |
| Cmh Newaygo County | $8 - $27 | 9% |
| Cmh North Country | $8 - $27 | 9% |
| Cmh Northern Lakes County | $8 - $27 | 9% |
| Cmh Oakland County | $8 - $27 | 9% |
| Cmh Ottawa County | $8 - $27 | 9% |
| Cmh Van Buren County | $8 - $27 | 9% |
| Cmh Washtenaw County | $8 - $27 | 9% |
| Cmh Wayne County/Carelink | $8 - $27 | 9% |
| Cmh Wayne Cty/Com Liv Svcs | $8 - $27 | 9% |
| Cmh West Mi County | $8 - $27 | 9% |
| Community Benefit Health | $8 - $27 | 9% |
| Community Care Behavorial Health | $8 - $27 | 9% |
| Community Care Partners | $8 - $27 | 9% |
| Community Health Choice | $8 - $27 | 9% |
| Connections Csp | $8 - $27 | 9% |
| County Coroner | $8 - $27 | 9% |
| County Funding Generic | $8 - $27 | 9% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $8 - $27 | 9% |
| Dean Wi Badgercare | $8 - $27 | 9% |
| Delaware County Department Of Health | $8 - $27 | 9% |
| Delaware First Health | $8 - $27 | 9% |
| Delta Dental Nj | $8 - $27 | 9% |
| Dph Tb Program | $8 - $27 | 9% |
| Dscc | $8 - $27 | 9% |
| Eastpointe Lme | $8 - $27 | 9% |
| Family Health Network | $8 - $27 | 9% |
| Freedom First Healthcare | $8 - $27 | 9% |
| Fresno County Ccs | $8 - $27 | 9% |
| Ghc Scw Wi Badgercare | $8 - $27 | 9% |
| Harbor Health | $8 - $27 | 9% |
| Health Safety Net | $8 - $27 | 9% |
| Healthy Blue Ne | $8 - $27 | 9% |
| Hennepin Health | $8 - $27 | 9% |
| Id County Ada | $8 - $27 | 9% |
| Id County Canyon | $8 - $27 | 9% |
| Id County Cat Fund | $8 - $27 | 9% |
| Id County Other | $8 - $27 | 9% |
| Id County Payette | $8 - $27 | 9% |
| Idaho Dept Health And Wellfare | $8 - $27 | 9% |
| Idaho Womens Health Check | $8 - $27 | 9% |
| Indiana Breast Cervical Cancer | $8 - $27 | 9% |
| Inland Empire Health Plan | $8 - $27 | 9% |
| Intercommunity Health Ohp | $8 - $27 | 9% |
| Iowa Health Advantage | $8 - $54 | 9% |
| Jai Medical System | $8 - $27 | 9% |
| Kern Family Health Plan | $8 - $27 | 9% |
| Keystone First | $8 - $27 | 9% |
| Keystone First Chip | $8 - $27 | 9% |
| La Care Health Plan | $8 - $27 | 9% |
| Lakeland Care Inc | $8 - $27 | 9% |
| Managed Health Services - Indiana | $8 - $27 | 9% |
| Maryland Breast & Cervical Program | $8 - $27 | 9% |
| Maryland Healthy Smiles - Scion Dental | $8 - $27 | 9% |
| Maryland Physicians Care | $8 - $27 | 9% |
| Massachusetts Behavioral Health Partnership | $8 - $27 | 9% |
| Mdwise | $8 - $27 | 9% |
| Medi-Cal | $8 - $27 | 9% |
| Medi-Cal Healthnet | $8 - $27 | 9% |
| Medstar Dc Healthy Family | $8 - $27 | 9% |
| Medstar Md Health Choice | $8 - $27 | 9% |
| Mo Home State Health Plan | $8 - $27 | 9% |
| Molina Centennial Care | $8 - $27 | 9% |
| Nascentia Health Options | $8 - $27 | 9% |
| New York Cancer Services Program | $8 - $27 | 9% |
| Nextlevel Health | $8 - $27 | 9% |
| Oregon Screenwise | $8 - $27 | 9% |
| Paramount Advantage | $8 - $27 | 9% |
| Parkland Community Health Plan | $8 - $27 | 9% |
| Partners Behavioral Lme | $8 - $27 | 9% |
| Peach State Healthplan | $8 - $27 | 9% |
| Philadelphia County Funding | $8 - $27 | 9% |
| Presbyterian Centennial Care | $8 - $27 | 9% |
| Prestige Health Choice | $8 - $27 | 9% |
| Priority Partners | $8 - $27 | 9% |
| Robert F Sing Program | $8 - $27 | 9% |
| Rx 340B Pass Along | $8 - $27 | 9% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $8 - $27 | 9% |
| Rx Medi-Cal | $8 - $27 | 9% |
| Rx Meridian Rx | $8 - $27 | 9% |
| Ryan White Florida Mssrp | $8 - $27 | 9% |
| Sandhills Center Lme | $8 - $27 | 9% |
| Screening For Life | $8 - $27 | 9% |
| St Joseph County Hlth Dpt | $8 - $27 | 9% |
| Stephenson Cty Health | $8 - $59 | 9% |
| Sunshine State Health Plan | $8 - $27 | 9% |
| Superior Health | $8 - $27 | 9% |
| Tenncare | $8 - $27 | 9% |
| Texas Children'S Health Plan | $8 - $27 | 9% |
| Trillium Community Ohp | $8 - $27 | 9% |
| Tufts Health Public Plans | $8 - $27 | 9% |
| Vaya Health Lme | $8 - $27 | 9% |
| Veterans Administration | $8 - $52 | 9% |
| Washtenaw Health Plan | $8 - $27 | 9% |
| Wellsense Health Plan | $8 - $27 | 9% |
| Wi Womens Wellness | $8 - $27 | 9% |
| Amish Hospital Aid | $9 - $201 | 10% |
| Wellpoint | $9 - $28 | 10% |
| Amps | $10 - $70 | 11% |
| Avera | $12 - $86 | 13% |
| Newton Correctional Facility | $12 - $113 | 13% |
| Claimdoc | $13 - $304 | 15% |
| Medical Associates | $13 - $399 | 15% |
| Nova | $13 - $304 | 15% |
| Sanford Health Plan | $13 - $92 | 15% |
| Bcn Domestic | $14 - $72 | 16% |
| Blue Benefit Administrators Of Massachusetts | $14 - $72 | 16% |
| Blue Care Network | $14 - $72 | 16% |
| Blue Distinction Transplant | $14 - $72 | 16% |
| Blue Shield - Ca | $14 - $72 | 16% |
| Blue Shield - Id (Regence) | $14 - $72 | 16% |
| Blue Shield - Ny Highmark Northeastern | $14 - $72 | 16% |
| Blue Shield - Ny Highmark Western | $14 - $72 | 16% |
| Blue Shield - Pa (Highmark) | $14 - $72 | 16% |
| Blue Shield - Wa (Regence) | $14 - $72 | 16% |
| Centivo | $14 - $99 | 16% |
| Genex Wc | $14 - $131 | 16% |
| Health Choices | $14 - $399 | 16% |
| Health Smart | $14 - $97 | 16% |
| Kaiser Domestic | $14 - $72 | 16% |
| Lucent Health | $14 - $489 | 16% |
| Meritain | $14 - $489 | 16% |
| Multiplan | $14 - $97 | 16% |
| Oscar | $14 - $93 | 16% |
| Pre-Employment | $14 - $72 | 16% |
| Ucare | $14 - $103 | 16% |
| Wc Align Network | $14 - $139 | 16% |
| Wc Domestic | $14 - $72 | 16% |
| Health Partners | $15 - $502 | 17% |
| Quiktrip | $15 - $102 | 17% |
| Usa Managed Care | $15 - $101 | 17% |
| Wc Praxis Health Network | $15 - $148 | 17% |
| Auto Velocity | $16 - $157 | 18% |
| Geha | $16 - $376 | 18% |
| Preferred One | $16 - $83 | 18% |
| The Alliance | $16 - $110 | 18% |
| Wc O'Hara Corp | $16 - $157 | 18% |
| Wc Reny Company | $16 - $151 | 18% |
| Wc Velocity | $16 - $151 | 18% |
| Global Excel | $17 - $118 | 19% |
| Allied Benefit Systems | $18 - $489 | 20% |
| Andrie Inc | $18 - $174 | 20% |
| Auxiant | $18 - $512 | 20% |
| East Greenbush Central School District | $18 - $174 | 20% |
| First Choice Health | $18 - $108 | 20% |
| Group Administrators | $18 - $108 | 20% |
| Healthsmart Workers Comp | $18 - $174 | 20% |
| Iowa Dept Of Public Health | $18 - $522 | 20% |
| Jag Source | $18 - $174 | 20% |
| Midlands | $18 - $512 | 20% |
| Midlands Choice | $18 - $512 | 20% |
| Nebraska Total Care | $18 - $91 | 20% |
| New York State Insurance Fund | $18 - $174 | 20% |
| Njm Insurance Group | $18 - $174 | 20% |
| Rx Heatlhcomp | $18 - $174 | 20% |
| Rx Restat | $18 - $174 | 20% |
| Rx Saif Opdp Wc | $18 - $174 | 20% |
| Rx Worker'S Comp | $18 - $174 | 20% |
| Velocity | $18 - $123 | 20% |
| Wc Accident Fund | $18 - $174 | 20% |
| Wc Ace | $18 - $174 | 20% |
| Wc Acs Federal Employees | $18 - $174 | 20% |
| Wc Acuity | $18 - $174 | 20% |
| Wc Advantage | $18 - $174 | 20% |
| Wc Aegis | $18 - $174 | 20% |
| Wc Aig | $18 - $174 | 20% |
| Wc Aims | $18 - $174 | 20% |
| Wc Alaska National Ins | $18 - $174 | 20% |
| Wc Allied | $18 - $174 | 20% |
| Wc Am Trust N America | $18 - $174 | 20% |
| Wc American Claims Mgmt | $18 - $174 | 20% |
| Wc Amerisure | $18 - $174 | 20% |
| Wc Amtrust | $18 - $174 | 20% |
| Wc Asu Risk Mgt | $18 - $174 | 20% |
| Wc Benetech | $18 - $174 | 20% |
| Wc Berkley Admin | $18 - $174 | 20% |
| Wc Broadspire | $18 - $174 | 20% |
| Wc Broward County | $18 - $174 | 20% |
| Wc Bunch & Associates | $18 - $174 | 20% |
| Wc California State Comp Ins | $18 - $174 | 20% |
| Wc California State Ins Fund | $18 - $174 | 20% |
| Wc Capitol Area Health Consortium | $18 - $174 | 20% |
| Wc Ccmsi | $18 - $174 | 20% |
| Wc Chartis | $18 - $174 | 20% |
| Wc Chubb | $18 - $174 | 20% |
| Wc Cirma | $18 - $174 | 20% |
| Wc City Of Albany | $18 - $174 | 20% |
| Wc City Of Sioux City | $18 - $174 | 20% |
| Wc Claims Mgmt Inc | $18 - $174 | 20% |
| Wc Cna | $18 - $174 | 20% |
| Wc Comp One Admin C/O Manageability | $18 - $174 | 20% |
| Wc Compone Admin | $18 - $174 | 20% |
| Wc Ct Healthcare Trust | $18 - $174 | 20% |
| Wc Donegal Insurance Group | $18 - $174 | 20% |
| Wc Emc Insurance Company | $18 - $174 | 20% |
| Wc Employee Mutual | $18 - $174 | 20% |
| Wc Enablecomp | $18 - $174 | 20% |
| Wc Encore Health Network | $18 - $174 | 20% |
| Wc Erie | $18 - $174 | 20% |
| Wc Esis | $18 - $174 | 20% |
| Wc Evolutions | $18 - $174 | 20% |
| Wc Fcci | $18 - $174 | 20% |
| Wc Fed Ex | $18 - $174 | 20% |
| Wc Federal Black Lung | $18 - $174 | 20% |
| Wc Federated | $18 - $174 | 20% |
| Wc Finley Occupational Health | $18 - $174 | 20% |
| Wc First Agency/Occunet | $18 - $174 | 20% |
| Wc Ford Motor | $18 - $174 | 20% |
| Wc Fresno Unified Emp | $18 - $174 | 20% |
| Wc Gallagher Bassett | $18 - $174 | 20% |
| Wc General Motors | $18 - $174 | 20% |
| Wc Generic | $18 - $174 | 20% |
| Wc Genex Care For Ohio | $18 - $174 | 20% |
| Wc Great West Casualty | $18 - $174 | 20% |
| Wc Guarantee Insurance | $18 - $174 | 20% |
| Wc Guard Insurance Company | $18 - $174 | 20% |
| Wc Hab | $18 - $174 | 20% |
| Wc Hartford | $18 - $174 | 20% |
| Wc Hastings | $18 - $174 | 20% |
| Wc Health Management | $18 - $174 | 20% |
| Wc Heritage Summit | $18 - $174 | 20% |
| Wc Hireright | $18 - $174 | 20% |
| Wc Horizon | $18 - $174 | 20% |
| Wc Icw Group | $18 - $174 | 20% |
| Wc Idaho State Ins Fund | $18 - $174 | 20% |
| Wc Intercare Insurance | $18 - $174 | 20% |
| Wc Intermountain | $18 - $174 | 20% |
| Wc Johns Eastern | $18 - $174 | 20% |
| Wc Kemberton | $18 - $174 | 20% |
| Wc Key Ins & Benefit Solutions | $18 - $174 | 20% |
| Wc Liberty Mutual | $18 - $174 | 20% |
| Wc Mac Risk Management | $18 - $174 | 20% |
| Wc Massachusetts | $18 - $174 | 20% |
| Wc Mdia | $18 - $174 | 20% |
| Wc Meadowbrook Claim | $18 - $174 | 20% |
| Wc Medical Administrators | $18 - $174 | 20% |
| Wc Meijers | $18 - $174 | 20% |
| Wc Memic | $18 - $174 | 20% |
| Wc Mercy Workcare | $18 - $174 | 20% |
| Wc Michigan | $18 - $174 | 20% |
| Wc Michigan Millers Mutual | $18 - $174 | 20% |
| Wc Mitchell Frankenmuth | $18 - $174 | 20% |
| Wc Mra | $18 - $174 | 20% |
| Wc Nationwide | $18 - $174 | 20% |
| Wc Nca Comp | $18 - $174 | 20% |
| Wc New York | $18 - $174 | 20% |
| Wc New York Special Funds | $18 - $174 | 20% |
| Wc North American Rishces | $18 - $174 | 20% |
| Wc Northeast Health | $18 - $174 | 20% |
| Wc Notre Dame | $18 - $174 | 20% |
| Wc Novanet | $18 - $174 | 20% |
| Wc Occ Health Allen | $18 - $174 | 20% |
| Wc Ohio Bureau | $18 - $174 | 20% |
| Wc One Call Medical | $18 - $174 | 20% |
| Wc Paradigm | $18 - $174 | 20% |
| Wc Peerless | $18 - $174 | 20% |
| Wc Pma | $18 - $174 | 20% |
| Wc Price Chopper | $18 - $174 | 20% |
| Wc Procura Management | $18 - $174 | 20% |
| Wc Qualcare | $18 - $174 | 20% |
| Wc Quiktrip | $18 - $174 | 20% |
| Wc Rev Claims | $18 - $174 | 20% |
| Wc Risico | $18 - $174 | 20% |
| Wc Rural Mutual | $18 - $174 | 20% |
| Wc Saif Oregon | $18 - $174 | 20% |
| Wc Secura | $18 - $174 | 20% |
| Wc Sedgwick | $18 - $174 | 20% |
| Wc Sentry | $18 - $174 | 20% |
| Wc Sheakley Unicomp | $18 - $174 | 20% |
| Wc Smile Lodge | $18 - $174 | 20% |
| Wc Society | $18 - $174 | 20% |
| Wc Srs | $18 - $174 | 20% |
| Wc Taconic (Mro) | $18 - $174 | 20% |
| Wc Taconic Farms | $18 - $174 | 20% |
| Wc Travelers | $18 - $174 | 20% |
| Wc Triad Group | $18 - $174 | 20% |
| Wc Tristar | $18 - $174 | 20% |
| Wc Troy Ny | $18 - $174 | 20% |
| Wc Tyson | $18 - $174 | 20% |
| Wc Unified Health Services | $18 - $174 | 20% |
| Wc United Heartland | $18 - $174 | 20% |
| Wc Us Dept Of Labor | $18 - $174 | 20% |
| Wc Walmart | $18 - $174 | 20% |
| Wc West Bend | $18 - $174 | 20% |
| Wc West Bend Mutual/Argent | $18 - $174 | 20% |
| Wc Winnebago Industries | $18 - $174 | 20% |
| Wc Yankee Trails | $18 - $174 | 20% |
| Wc York Risk | $18 - $174 | 20% |
| Wc Zenith | $18 - $174 | 20% |
| Wc Zurich | $18 - $174 | 20% |
| 1199 National Benefit Fund | $22 - $489 | 25% |
| Asr Health Benefits | $22 - $489 | 25% |
| Christian Brother Services | $22 - $489 | 25% |
| Coventry | $22 - $489 | 25% |
| First Health | $22 - $489 | 25% |
| Luminare Health | $22 - $489 | 25% |
| Medical Mutual | $22 - $489 | 25% |
| Trustmark Small Business Benefits | $22 - $489 | 25% |
| Webtpa | $22 - $489 | 25% |
| Crime Victim Assistance | $23 - $522 | 26% |
| Medica | $23 - $512 | 26% |