CMS Price Transparency Data
Ultrasound, pelvis
Facility: Samaritan Hospital of Troy, New York
Billing Code: 76856 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 76856
- Insurance Median: $271
- Cash Discount Price: $271
- vs. Medicare Baseline: 2.54x Medicare
The contracted insurance negotiated median rate for a Ultrasound, pelvis at Samaritan Hospital of Troy, New York is $271. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $271. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.54x the Medicare baseline. Located in 2215 Burdett Avenue, Troy, NY.
Cash / Self-Pay
$271
Average discount available for prompt cash payment at this facility.
Insurance Median
$271
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$106.81
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $106.81 (100%)
Cash / Self-Pay: $271 (254%)
Insurance Median: $271 (254%)
Cash: $271 (254% of Medicare)
Ins. Median: $271 (254% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $106.81 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 254% of the Medicare baseline (a markup of 154%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $21 - $1,379 | 20% |
| Champva | $29 - $93 | 27% |
| Humana | $29 - $274 | 27% |
| Tricare | $29 - $93 | 27% |
| Triwest Health Alliance | $29 - $93 | 27% |
| Veterans Eval Services | $29 - $93 | 27% |
| Medicare (plans) | $31 - $1,379 | 29% |
| Us Family Health Plan | $31 - $97 | 29% |
| Aetna | $32 - $274 | 30% |
| Veterans Administration | $32 - $101 | 30% |
| Hudson Headwaters Pace | $34 - $141 | 32% |
| UnitedHealthcare | $46 - $1,379 | 43% |
| Albany County Correctional Facility | $56 - $274 | 52% |
| Nascentia Health Options | $56 - $274 | 52% |
| Blue Cross Blue Shield | $59 - $325 | 55% |
| Coventry | $60 - $193 | 56% |
| Geha | $60 - $274 | 56% |
| Meritain | $60 - $193 | 56% |
| 1199 National Benefit Fund | $85 - $274 | 80% |
| Aarp | $85 - $274 | 80% |
| Access Health | $85 - $274 | 80% |
| Acclaim | $85 - $274 | 80% |
| Acs Benefit Services | $85 - $274 | 80% |
| Actin Care Groups | $85 - $274 | 80% |
| Ada County Jail Inmate Ins | $85 - $274 | 80% |
| Adamh Board | $85 - $274 | 80% |
| Administrative Concepts | $85 - $274 | 80% |
| Admiral Life | $85 - $274 | 80% |
| Advanced Correctional Healthcare | $85 - $274 | 80% |
| Advantek Central Usd | $85 - $274 | 80% |
| Adventist Health Plan | $85 - $274 | 80% |
| Advocate Health | $85 - $274 | 80% |
| Aflac | $85 - $274 | 80% |
| Albany County Nursing Home | $85 - $274 | 80% |
| Albany County Office For Aging | $85 - $274 | 80% |
| Align Senior Care | $85 - $274 | 80% |
| Allegeant | $85 - $274 | 80% |
| Allegiance | $85 - $384 | 80% |
| Alliant Health Plans | $85 - $274 | 80% |
| Allianz Global Assistance | $85 - $274 | 80% |
| Allied Benefit Systems | $85 - $274 | 80% |
| Allied Community Service | $85 - $274 | 80% |
| Allied National Global Care | $85 - $274 | 80% |
| Ally Align Care Adv | $85 - $274 | 80% |
| Alta Health | $85 - $274 | 80% |
| Altrua Healthshare Co Zelis | $85 - $274 | 80% |
| Am First Insurance Company | $85 - $274 | 80% |
| Amalgamated | $85 - $274 | 80% |
| Ambetter / Centene | $85 - $274 | 80% |
| Ameriben | $85 - $274 | 80% |
| America'S Tpa | $85 - $274 | 80% |
| American Family | $85 - $274 | 80% |
| American Health Advantage Of Idaho | $85 - $274 | 80% |
| American Health Plan | $85 - $274 | 80% |
| American Healthcare Alliance | $85 - $274 | 80% |
| American National | $85 - $274 | 80% |
| American Postal Workers Secondary | $85 - $384 | 80% |
| American Public Life | $85 - $274 | 80% |
| American Republic | $85 - $274 | 80% |
| Amerihealth | $85 - $274 | 80% |
| Amerihealth Caritas Next | $85 - $274 | 80% |
| Amish Hospital Aid | $85 - $274 | 80% |
| Amish Mennonite | $85 - $274 | 80% |
| Amps | $85 - $274 | 80% |
| Andrie Inc | $85 - $274 | 80% |
| Angela Hospice | $85 - $274 | 80% |
| Apostrophe | $85 - $274 | 80% |
| Arbor Hospice | $85 - $274 | 80% |
| Ascension St. Vincent Public Safety Medical | $85 - $274 | 80% |
| Asi - Navia Benefit Solutions | $85 - $274 | 80% |
| Asr Health Benefits | $85 - $274 | 80% |
| Asrm - Reliance Standard Life Insurance | $85 - $274 | 80% |
| Asuris Northwest Health | $85 - $274 | 80% |
| Attleboro Nursing & Rehab | $85 - $274 | 80% |
| Aultcare | $85 - $274 | 80% |
| Aurora Special Needs | $85 - $274 | 80% |
| Auto Aaa | $85 - $274 | 80% |
| Auto Acuity | $85 - $274 | 80% |
| Auto Allstate | $85 - $274 | 80% |
| Auto American Family | $85 - $274 | 80% |
| Auto American Modern Ins Co | $85 - $274 | 80% |
| Auto Amerisure | $85 - $274 | 80% |
| Auto Bristol West | $85 - $274 | 80% |
| Auto Citizens | $85 - $274 | 80% |
| Auto Dairyland | $85 - $274 | 80% |
| Auto Encompass | $85 - $274 | 80% |
| Auto Erie | $85 - $274 | 80% |
| Auto Esurance | $85 - $274 | 80% |
| Auto Farm Bureau | $85 - $274 | 80% |
| Auto Farmers Insurance | $85 - $274 | 80% |
| Auto Fremont Mutual | $85 - $274 | 80% |
| Auto Geico | $85 - $274 | 80% |
| Auto Generic | $85 - $274 | 80% |
| Auto Hartford | $85 - $274 | 80% |
| Auto Kemberton | $85 - $274 | 80% |
| Auto Kemper | $85 - $274 | 80% |
| Auto Liabililty Praxis | $85 - $274 | 80% |
| Auto Liberty Mutual | $85 - $274 | 80% |
| Auto Mackinaw Administrators | $85 - $274 | 80% |
| Auto Manageability | $85 - $274 | 80% |
| Auto Meadowbrook | $85 - $274 | 80% |
| Auto Metlife | $85 - $274 | 80% |
| Auto Mra | $85 - $274 | 80% |
| Auto Nationwide | $85 - $274 | 80% |
| Auto New York Central Mutual | $85 - $274 | 80% |
| Auto New York No Fault | $85 - $274 | 80% |
| Auto Owners | $85 - $274 | 80% |
| Auto Progressive | $85 - $274 | 80% |
| Auto Safeco | $85 - $274 | 80% |
| Auto State Farm | $85 - $274 | 80% |
| Auto Titan | $85 - $274 | 80% |
| Auto Travelers | $85 - $274 | 80% |
| Auto Usaa | $85 - $274 | 80% |
| Auto Velocity | $85 - $274 | 80% |
| Automated Benefit Services | $85 - $274 | 80% |
| Auxiant | $85 - $274 | 80% |
| Avera | $85 - $274 | 80% |
| Avmed Health Plan | $85 - $274 | 80% |
| Axa Assistance Us | $85 - $274 | 80% |
| Axis Services | $85 - $274 | 80% |
| Bankers Fidelity | $85 - $274 | 80% |
| Bankers Life Casualty | $85 - $274 | 80% |
| Barinet | $85 - $274 | 80% |
| Barnwell Nursing Rehab Center | $85 - $274 | 80% |
| Bcccp-Michigan | $85 - $274 | 80% |
| Bccp | $85 - $274 | 80% |
| Bcn Domestic | $85 - $300 | 80% |
| Behavioral Health Services | $85 - $274 | 80% |
| Benefit Administrative Systems,Llc | $85 - $274 | 80% |
| Benesight | $85 - $274 | 80% |
| Bethlehem Commons At Gsv | $85 - $274 | 80% |
| Blue Benefit Administrators Of Massachusetts | $85 - $274 | 80% |
| Blue Care Network | $85 - $300 | 80% |
| Blue Care Network Advantage | $85 - $274 | 80% |
| Blue Distinction Transplant | $85 - $274 | 80% |
| Blue Shield - Ca | $85 - $325 | 80% |
| Blue Shield - De (Highmark) Medciare Advantage | $85 - $274 | 80% |
| Blue Shield - Id (Regence) | $85 - $325 | 80% |
| Blue Shield - Ny Highmark Northeastern | $85 - $325 | 80% |
| Blue Shield - Ny Highmark Western | $85 - $325 | 80% |
| Blue Shield - Pa (Highmark) | $85 - $325 | 80% |
| Blue Shield - Wa (Regence) | $85 - $325 | 80% |
| Bmc Healthnet | $85 - $274 | 80% |
| Bmi Benefits | $85 - $274 | 80% |
| Boon Chapman | $85 - $274 | 80% |
| Breast Grant-Connecticut | $85 - $274 | 80% |
| Bridge Health | $85 - $274 | 80% |
| Bridge Health Bundle | $85 - $274 | 80% |
| Bright Healthcare | $85 - $274 | 80% |
| Brms | $85 - $274 | 80% |
| Broward County Dept Of Health | $85 - $274 | 80% |
| Bureau Of Disability | $85 - $274 | 80% |
| California Health And Wellness | $85 - $274 | 80% |
| Cam Administrative Services | $85 - $274 | 80% |
| Capital District Physicians Health Plan | $85 - $274 | 80% |
| Caprock Health Plans | $85 - $274 | 80% |
| Cardea Benefits Limited | $85 - $274 | 80% |
| Cardinal Innovations Lme | $85 - $274 | 80% |
| Care Connections Of Northern Iowa | $85 - $274 | 80% |
| Care Dimensions | $85 - $274 | 80% |
| Care Improvement Plus | $85 - $274 | 80% |
| Care Oregon Ohp | $85 - $274 | 80% |
| Care Resources Pace | $85 - $274 | 80% |
| Carebridge Eap | $85 - $274 | 80% |
| Carefirst | $85 - $274 | 80% |
| Carelon Behavioral Health | $85 - $1,379 | 80% |
| Careplus Health Plans | $85 - $274 | 80% |
| Caresource | $85 - $274 | 80% |
| Careworks | $85 - $274 | 80% |
| Carisk | $85 - $274 | 80% |
| Catholic Hospice | $85 - $274 | 80% |
| Cba Network By Design | $85 - $274 | 80% |
| Cca - Zing Health | $85 - $274 | 80% |
| Cca Senior Care Options | $85 - $274 | 80% |
| Cedar Network | $85 - $274 | 80% |
| Cedar Valley | $85 - $274 | 80% |
| Cencal Health Plan | $85 - $274 | 80% |
| Cenpatico | $85 - $274 | 80% |
| Centivo | $85 - $274 | 80% |
| Central States Indemnity | $85 - $274 | 80% |
| Central Valley Medical Services Corp Pace | $85 - $274 | 80% |
| Centurion Of Idaho | $85 - $274 | 80% |
| Ceridian Eap - Lifeworks | $85 - $274 | 80% |
| Champion Health Plan Mcr Advantage | $85 - $274 | 80% |
| Chandler Hall Hospice | $85 - $274 | 80% |
| Chandler Hall Nursing Home | $85 - $274 | 80% |
| Chesterfield Resources | $85 - $274 | 80% |
| Chhuny | $85 - $274 | 80% |
| Childrens Comm Health Plan | $85 - $274 | 80% |
| Childrens Medical Services Title 19 | $85 - $274 | 80% |
| Choiceone | $85 - $274 | 80% |
| Christian Brother Services | $85 - $274 | 80% |
| Christian Brothers Holy Cross | $85 - $274 | 80% |
| Christian Care Ministry | $85 - $274 | 80% |
| Cigna | $85 - $384 | 80% |
| City Of Philadelphia | $85 - $274 | 80% |
| Claimchoice Adminstrators | $85 - $274 | 80% |
| Claimdoc | $85 - $274 | 80% |
| Claimsbridge | $85 - $274 | 80% |
| Clear Spring Health | $85 - $274 | 80% |
| Clover Health | $85 - $274 | 80% |
| Cmh Allegan County | $85 - $274 | 80% |
| Cmh Ausable Valley | $85 - $274 | 80% |
| Cmh Barry County | $85 - $274 | 80% |
| Cmh Bay-Arenac County | $85 - $274 | 80% |
| Cmh Berrien County | $85 - $274 | 80% |
| Cmh Cass County | $85 - $274 | 80% |
| Cmh Central Mi County | $85 - $274 | 80% |
| Cmh Clinton-Eaton-Ingham County | $85 - $274 | 80% |
| Cmh Detroit Wayne Integrated Health Network | $85 - $274 | 80% |
| Cmh Genesee County | $85 - $274 | 80% |
| Cmh Ionia County | $85 - $274 | 80% |
| Cmh Jackson County/Lifeways | $85 - $274 | 80% |
| Cmh Kalamazoo | $85 - $274 | 80% |
| Cmh Kent County | $85 - $274 | 80% |
| Cmh Lenawee County | $85 - $274 | 80% |
| Cmh Livingston County | $85 - $274 | 80% |
| Cmh Macomb | $85 - $274 | 80% |
| Cmh Misc | $85 - $274 | 80% |
| Cmh Monroe County | $85 - $274 | 80% |
| Cmh Montcalm County | $85 - $274 | 80% |
| Cmh Muskegon County | $85 - $274 | 80% |
| Cmh Newaygo County | $85 - $274 | 80% |
| Cmh North Country | $85 - $274 | 80% |
| Cmh Northern Lakes County | $85 - $274 | 80% |
| Cmh Oakland County | $85 - $274 | 80% |
| Cmh Ottawa County | $85 - $274 | 80% |
| Cmh Van Buren County | $85 - $274 | 80% |
| Cmh Washtenaw County | $85 - $274 | 80% |
| Cmh Wayne County/Carelink | $85 - $274 | 80% |
| Cmh Wayne Cty/Com Liv Svcs | $85 - $274 | 80% |
| Cmh West Mi County | $85 - $274 | 80% |
| Cmn Global | $85 - $274 | 80% |
| Columbia Health Network | $85 - $274 | 80% |
| Comed | $85 - $274 | 80% |
| Comfort Care Of Cayuga County | $85 - $274 | 80% |
| Common Ground | $85 - $274 | 80% |
| Commonwealth Care Alliance | $85 - $274 | 80% |
| Community Behavioral Health | $85 - $274 | 80% |
| Community Benefit Health | $85 - $274 | 80% |
| Community Care Associates | $85 - $274 | 80% |
| Community Care Behavorial Health | $85 - $274 | 80% |
| Community Care Health Hmo Oon | $85 - $274 | 80% |
| Community Care Partners | $85 - $274 | 80% |
| Community Care Plan | $85 - $274 | 80% |
| Community Health Alliance | $85 - $274 | 80% |
| Community Health Choice | $85 - $274 | 80% |
| Community Hospice Inc | $85 - $274 | 80% |
| Community Pace At Home | $85 - $274 | 80% |
| Community Place Fremont | $85 - $274 | 80% |
| Compcare | $85 - $274 | 80% |
| Comprehensive Benefits | $85 - $274 | 80% |
| Compsych | $85 - $274 | 80% |
| Compsych Eap | $85 - $274 | 80% |
| Connecticare | $85 - $274 | 80% |
| Connecticut Court Support Services | $85 - $274 | 80% |
| Connecticut Dept Of Correction | $85 - $274 | 80% |
| Connections Csp | $85 - $274 | 80% |
| Consociate | $85 - $274 | 80% |
| Consolidated Health Plan | $85 - $274 | 80% |
| Constitution Life | $85 - $274 | 80% |
| Consumer Health Network | $85 - $274 | 80% |
| Continental American | $85 - $274 | 80% |
| Continental Life Insurance | $85 - $274 | 80% |
| Cook County Risk Management | $85 - $274 | 80% |
| Core Benefits | $85 - $274 | 80% |
| Correctcare Integrated Health | $85 - $274 | 80% |
| Corrected Solutions | $85 - $274 | 80% |
| Correctional Health Partners | $85 - $274 | 80% |
| Correctional Healthcare Consultants | $85 - $274 | 80% |
| Correctional Recovery | $85 - $274 | 80% |
| Country Life Ins | $85 - $274 | 80% |
| County Coroner | $85 - $274 | 80% |
| County Funding Generic | $85 - $274 | 80% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $85 - $274 | 80% |
| Crime Victim Assistance | $85 - $274 | 80% |
| Csea | $85 - $274 | 80% |
| Curative | $85 - $274 | 80% |
| Custom Benefit Administrators | $85 - $274 | 80% |
| Custom Design Benefits | $85 - $274 | 80% |
| Cypress Benefit Administrators | $85 - $274 | 80% |
| Dakotacare | $85 - $274 | 80% |
| Daughters Of Sarah Nursing Center | $85 - $274 | 80% |
| Davita | $85 - $274 | 80% |
| Dcfs | $85 - $274 | 80% |
| Dci Laboratory | $85 - $274 | 80% |
| Dean Health | $85 - $274 | 80% |
| Dean Wi Badgercare | $85 - $274 | 80% |
| Delaware County Department Of Health | $85 - $274 | 80% |
| Delaware First Health | $85 - $274 | 80% |
| Delta Dental Ga | $85 - $274 | 80% |
| Delta Dental Il | $85 - $274 | 80% |
| Delta Dental Mo | $85 - $274 | 80% |
| Delta Dental Nj | $85 - $274 | 80% |
| Delta Dental Ny | $85 - $274 | 80% |
| Delta Dental Oh | $85 - $274 | 80% |
| Delta Dental Or | $85 - $274 | 80% |
| Delta Dental Pa | $85 - $274 | 80% |
| Delta Dental Va | $85 - $274 | 80% |
| Delta Dental Wa | $85 - $274 | 80% |
| Dental Generic | $85 - $274 | 80% |
| Dentaquest | $85 - $274 | 80% |
| Deseret Mutual | $85 - $274 | 80% |
| Desjardins Financial Security Life Assurance | $85 - $274 | 80% |
| Devon Health Services | $85 - $274 | 80% |
| Diamond Hill Nursing & Rehabilitation Center | $85 - $274 | 80% |
| Diversified Administrators | $85 - $384 | 80% |
| Dph Tb Program | $85 - $274 | 80% |
| Dscc | $85 - $274 | 80% |
| Eac Eap | $85 - $274 | 80% |
| East Greenbush Central School District | $85 - $274 | 80% |
| Eastpointe Lme | $85 - $274 | 80% |
| Eddy Nursing Homes | $85 - $274 | 80% |
| Eddy Senior Care-Pace | $85 - $274 | 80% |
| Eddy Seniorcare Pace | $85 - $274 | 80% |
| Edis Employer Driven Ins Services | $85 - $274 | 80% |
| Edward Hines Va | $85 - $274 | 80% |
| Elementcare | $85 - $274 | 80% |
| Emblem Health | $85 - $896 | 80% |
| Emerging Therapy Solutions Transplant | $85 - $274 | 80% |
| Empathia Eap | $85 - $274 | 80% |
| Employee Benefit Concepts | $85 - $274 | 80% |
| Employee Benefit Logistic | $85 - $274 | 80% |
| Employee Benefit Management | $85 - $274 | 80% |
| Employee Benefits Systems | $85 - $274 | 80% |
| Encore Health | $85 - $274 | 80% |
| Enfield Vna Hospice | $85 - $274 | 80% |
| Enterprise Group Planning | $85 - $274 | 80% |
| Envolve | $85 - $274 | 80% |
| Equitable Life | $85 - $274 | 80% |
| Evercare | $85 - $274 | 80% |
| Everence | $85 - $274 | 80% |
| Evergreen Commons | $85 - $274 | 80% |
| Evolutions Healthcare System | $85 - $274 | 80% |
| Eye Med | $85 - $274 | 80% |
| Fallon Health | $85 - $274 | 80% |
| Family Health Network | $85 - $274 | 80% |
| Family Life Insurance Company | $85 - $274 | 80% |
| Fidelis Care | $85 - $274 | 80% |
| First Choice Health | $85 - $274 | 80% |
| First Health | $85 - $1,103 | 80% |
| Forest County Potawatomi | $85 - $274 | 80% |
| Forethought Life Insurance Company | $85 - $274 | 80% |
| Franklin Co Sheriff Dept | $85 - $274 | 80% |
| Freedom First Healthcare | $85 - $274 | 80% |
| Freedom Life Insurance Company | $85 - $274 | 80% |
| Fresno County Ccs | $85 - $274 | 80% |
| Friday Health Plans | $85 - $274 | 80% |
| Fvosa | $85 - $274 | 80% |
| Galaxy Health Network | $85 - $274 | 80% |
| Gateway Health Plan | $85 - $274 | 80% |
| Geisinger Health Plan | $85 - $274 | 80% |
| General Electric | $85 - $274 | 80% |
| Genesys Pace Of Genesee County | $85 - $274 | 80% |
| Genex Wc | $85 - $274 | 80% |
| Georgia Health Advantage | $85 - $274 | 80% |
| Gerber Life Insurance | $85 - $274 | 80% |
| Ghc Scw | $85 - $274 | 80% |
| Ghc Scw Wi Badgercare | $85 - $274 | 80% |
| Gift Of Hope | $85 - $274 | 80% |
| Global Benefits Group | $85 - $274 | 80% |
| Global Excel | $85 - $274 | 80% |
| Global Health Claim Services | $85 - $274 | 80% |
| Global Medical Management | $85 - $274 | 80% |
| Global Reach Health | $85 - $274 | 80% |
| Gold Advantage | $85 - $274 | 80% |
| Goshen Preferred Network | $85 - $274 | 80% |
| Gpa Croell Redi Mix | $85 - $274 | 80% |
| Gpm Life | $85 - $274 | 80% |
| Gravie Admin Services | $85 - $274 | 80% |
| Great Southern Life | $85 - $274 | 80% |
| Greek Catholic Union | $85 - $274 | 80% |
| Greene County Sheriff Dept | $85 - $274 | 80% |
| Group Administrators | $85 - $274 | 80% |
| Group Health Cooperative | $85 - $274 | 80% |
| Group Management Services | $85 - $274 | 80% |
| Group Marketing Services | $85 - $274 | 80% |
| Group Pension Administrators | $85 - $274 | 80% |
| Guarantee Trust Life | $85 - $274 | 80% |
| Guardian | $85 - $274 | 80% |
| Hap | $85 - $274 | 80% |
| Harbor Health | $85 - $274 | 80% |
| Harmony Health Plan | $85 - $274 | 80% |
| Harvard Pilgrim Healthcare | $85 - $274 | 80% |
| Health Alliance | $85 - $274 | 80% |
| Health America | $85 - $274 | 80% |
| Health America Advantra | $85 - $274 | 80% |
| Health Choices | $85 - $274 | 80% |
| Health Connecticut | $85 - $274 | 80% |
| Health Cost Solutions | $85 - $274 | 80% |
| Health Design | $85 - $274 | 80% |
| Health Economics Corp | $85 - $274 | 80% |
| Health New England | $85 - $1,241 | 80% |
| Health Ohio Network | $85 - $274 | 80% |
| Health Partners | $85 - $384 | 80% |
| Health Plans Inc | $85 - $274 | 80% |
| Health Republic | $85 - $1,172 | 80% |
| Health Safety Net | $85 - $274 | 80% |
| Health Smart | $85 - $274 | 80% |
| Health-Share Generic | $85 - $274 | 80% |
| Healthadvocate Eap | $85 - $274 | 80% |
| Healthbridge Financial | $85 - $274 | 80% |
| Healthcare Management Admin | $85 - $274 | 80% |
| Healthchoice | $85 - $274 | 80% |
| Healthcomp | $85 - $274 | 80% |
| Healthez | $85 - $274 | 80% |
| Healthfirst | $85 - $274 | 80% |
| Healthfirst Tpa | $85 - $274 | 80% |
| Healthgram | $85 - $274 | 80% |
| Healthlink | $85 - $274 | 80% |
| Healthlink Inc | $85 - $274 | 80% |
| Healthnet | $85 - $274 | 80% |
| Healthplex | $85 - $274 | 80% |
| Healthscope | $85 - $274 | 80% |
| Healthsmart Workers Comp | $85 - $274 | 80% |
| Healthspan | $85 - $274 | 80% |
| Healthy Blue Ne | $85 - $274 | 80% |
| Heartland Hospice | $85 - $274 | 80% |
| Helpnet Eap | $85 - $274 | 80% |
| Hennepin Health | $85 - $274 | 80% |
| Hfn Inc | $85 - $274 | 80% |
| Highmark Health Options Dual Plan | $85 - $274 | 80% |
| Homemed Home Infusion | $85 - $274 | 80% |
| Homestead Health Plans Woods Center | $85 - $274 | 80% |
| Hope Select Pace | $85 - $274 | 80% |
| Horizon Nj Total Care | $85 - $274 | 80% |
| Hospice Advantage | $85 - $274 | 80% |
| Hospice Centeral Ny And Finger Lakes | $85 - $274 | 80% |
| Hospice Emmanuel | $85 - $274 | 80% |
| Hospice Faith | $85 - $274 | 80% |
| Hospice Generic | $85 - $274 | 80% |
| Hospice Harbor Hospice | $85 - $274 | 80% |
| Hospice Heart And Home | $85 - $274 | 80% |
| Hospice Lewis County | $85 - $274 | 80% |
| Hospice Mount Carmel | $85 - $274 | 80% |
| Hospice Of Holland | $85 - $274 | 80% |
| Hospice Of Lansing | $85 - $274 | 80% |
| Hospice Of Marshall County | $85 - $274 | 80% |
| Hospice Of Michigan | $85 - $274 | 80% |
| Hospice Of St Joseph County | $85 - $274 | 80% |
| Hospice Of Wapello Co | $85 - $274 | 80% |
| Hospice Oneida County | $85 - $274 | 80% |
| Hospice Vitas | $85 - $274 | 80% |
| Hospital For Special Care | $85 - $274 | 80% |
| Huron Valley Pace | $85 - $274 | 80% |
| Id County Ada | $85 - $274 | 80% |
| Id County Canyon | $85 - $274 | 80% |
| Id County Cat Fund | $85 - $274 | 80% |
| Id County Other | $85 - $274 | 80% |
| Id County Payette | $85 - $274 | 80% |
| Idaho Dept Health And Wellfare | $85 - $274 | 80% |
| Idaho Womens Health Check | $85 - $274 | 80% |
| Iha Idaho Self Pay Informational | $85 - $274 | 80% |
| Iha Indiana Self Pay Informational | $85 - $274 | 80% |
| Iha Iowa Self Pay Informational | $85 - $274 | 80% |
| Illinicare Health | $85 - $274 | 80% |
| In - Chambercare | $85 - $274 | 80% |
| Independent Health | $85 - $1,172 | 80% |
| Independent Living Center Of The Hudson Valley | $85 - $274 | 80% |
| Indian Health Services | $85 - $274 | 80% |
| Indiana Breast Cervical Cancer | $85 - $274 | 80% |
| Indiana Criminal Justice Inst | $85 - $274 | 80% |
| Indiana University Transplant | $85 - $274 | 80% |
| Individual Assurance Co | $85 - $274 | 80% |
| Inland Empire Health Plan | $85 - $274 | 80% |
| Innovative Health Plan Ii | $85 - $274 | 80% |
| Innovative Integrated Health Community Plans | $85 - $274 | 80% |
| Insight | $85 - $274 | 80% |
| Insurance Programmers Inc | $85 - $274 | 80% |
| Intercare | $85 - $274 | 80% |
| Intercommunity Health Ohp | $85 - $274 | 80% |
| International Benefit Administrators | $85 - $274 | 80% |
| International Generic | $85 - $274 | 80% |
| Interplan | $85 - $274 | 80% |
| Iowa Critical Access Transfers | $85 - $274 | 80% |
| Iowa Dept Of Public Health | $85 - $274 | 80% |
| Iowa Health Advantage | $85 - $274 | 80% |
| Iowa Total Care | $85 - $274 | 80% |
| Jag Source | $85 - $274 | 80% |
| Jai Medical System | $85 - $274 | 80% |
| Jefferson Health Plan Commercial | $85 - $274 | 80% |
| Jesse Brown | $85 - $274 | 80% |
| Jfp Benefit Management | $85 - $274 | 80% |
| Johns Hopkins Advantage Md | $85 - $274 | 80% |
| Johns Hopkins Health Plan | $85 - $274 | 80% |
| Jones Farm | $85 - $274 | 80% |
| Jp Farley Corporation | $85 - $274 | 80% |
| June E Nylen Cancer Ctr | $85 - $274 | 80% |
| Jvhl Amerihealth Caritas | $85 - $274 | 80% |
| Jvhl Asr | $85 - $274 | 80% |
| Jvhl Bcn | $85 - $274 | 80% |
| Jvhl Bcn Advantge Ptb | $85 - $274 | 80% |
| Jvhl Bcn Preff Hmo Hx | $85 - $274 | 80% |
| Jvhl Bcn Select Hmo | $85 - $274 | 80% |
| Jvhl Comm Care | $85 - $274 | 80% |
| Jvhl Comm Care Partnr | $85 - $274 | 80% |
| Jvhl Community Care | $85 - $274 | 80% |
| Jvhl Dmc Care Par | $85 - $274 | 80% |
| Jvhl Hap Alliance | $85 - $274 | 80% |
| Jvhl Hap Caresource | $85 - $274 | 80% |
| Jvhl Hap Empowered | $85 - $274 | 80% |
| Jvhl Hap Hmo/Pos | $85 - $274 | 80% |
| Jvhl Hap Ppo | $85 - $274 | 80% |
| Jvhl Hap Senior Plus | $85 - $274 | 80% |
| Jvhl Harbor Health | $85 - $274 | 80% |
| Jvhl Mc Plus Blue Ppo | $85 - $274 | 80% |
| Jvhl Mclaren Comm Hmo | $85 - $274 | 80% |
| Jvhl Mclaren Hlth Hmo | $85 - $274 | 80% |
| Jvhl Mclaren Hlth Ppo | $85 - $274 | 80% |
| Jvhl Mclaren Hmo Hx | $85 - $274 | 80% |
| Jvhl Meridian Hlth Pl | $85 - $274 | 80% |
| Jvhl Molina Advan Hmo | $85 - $274 | 80% |
| Jvhl Molina Hlth | $85 - $274 | 80% |
| Jvhl Molina Mkthmo | $85 - $274 | 80% |
| Jvhl Mypriority Hmo | $85 - $274 | 80% |
| Jvhl Mypriority Ppo | $85 - $274 | 80% |
| Jvhl Php | $85 - $274 | 80% |
| Jvhl Ppo Priority Hth | $85 - $274 | 80% |
| Jvhl Ppom/Cofinity Dm | $85 - $274 | 80% |
| Jvhl Priority Health | $85 - $274 | 80% |
| Jvhl Priority Hl Caid | $85 - $274 | 80% |
| Jvhl Secure Horizon | $85 - $274 | 80% |
| Jvhl United Hlth/Metr | $85 - $274 | 80% |
| Jvhl Wellcare | $85 - $274 | 80% |
| Kaiser Domestic | $85 - $274 | 80% |
| Kaiser Permanente | $85 - $274 | 80% |
| Kent County Jail | $85 - $274 | 80% |
| Kern Family Health Plan | $85 - $274 | 80% |
| Key Benefit Administrator | $85 - $274 | 80% |
| Keystone First | $85 - $274 | 80% |
| Keystone First Chip | $85 - $274 | 80% |
| Kidney Donor | $85 - $274 | 80% |
| La Care Health Plan | $85 - $274 | 80% |
| Laborcare | $85 - $274 | 80% |
| Lahey Davis Vision | $85 - $274 | 80% |
| Lakeland Care Inc | $85 - $274 | 80% |
| Land Of Lincoln | $85 - $274 | 80% |
| Lantern Insurance | $85 - $274 | 80% |
| Lasso Healthcare Msa | $85 - $274 | 80% |
| Liability Other | $85 - $274 | 80% |
| Liberty Dental | $85 - $274 | 80% |
| Liberty Healthshare | $85 - $274 | 80% |
| Liberty Union Life Assurance Co | $85 - $274 | 80% |
| Life St Marys Pace | $85 - $274 | 80% |
| Lifecircles Pace | $85 - $274 | 80% |
| Lifetime Benefit Solutions | $85 - $274 | 80% |
| Lifetrac | $85 - $274 | 80% |
| Lifewise | $85 - $274 | 80% |
| Local - Ct | $85 - $274 | 80% |
| Local 671 Health Services | $85 - $274 | 80% |
| Logistics Health Inc | $85 - $274 | 80% |
| Longevity Health Plan | $85 - $274 | 80% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $85 - $274 | 80% |
| Loyal American Life Insurance | $85 - $274 | 80% |
| Lucent Health | $85 - $274 | 80% |
| Luminare Health | $85 - $274 | 80% |
| Luminare Health (Detroit) | $85 - $274 | 80% |
| Madden | $85 - $274 | 80% |
| Maestro Health | $85 - $274 | 80% |
| Magellan Behavioral Health | $85 - $274 | 80% |
| Magellan Eap | $85 - $274 | 80% |
| Magellan Easp - Us Post Office | $85 - $274 | 80% |
| Magnacare | $85 - $1,172 | 80% |
| Malta House | $85 - $274 | 80% |
| Managed Health Services - Indiana | $85 - $274 | 80% |
| Manhattan Life | $85 - $274 | 80% |
| Marsh | $85 - $274 | 80% |
| Martins Point Generations Advantage | $85 - $274 | 80% |
| Maryland Breast & Cervical Program | $85 - $274 | 80% |
| Maryland Healthy Smiles - Scion Dental | $85 - $274 | 80% |
| Maryland Physicians Care | $85 - $274 | 80% |
| Mashantucket Pequot | $85 - $274 | 80% |
| Mass General Brigham Health Plan | $85 - $274 | 80% |
| Mass General Brigham Hmo | $85 - $274 | 80% |
| Mass General Brigham Mcr Adv | $85 - $274 | 80% |
| Massachusetts Behavioral Health Partnership | $85 - $274 | 80% |
| Massachusetts Dept Of Public Health | $85 - $274 | 80% |
| Mclaren Health | $85 - $274 | 80% |
| Mdwise | $85 - $274 | 80% |
| Medben | $85 - $274 | 80% |
| Medcost | $85 - $274 | 80% |
| Medex | $85 - $274 | 80% |
| Medi Share | $85 - $274 | 80% |
| Medi-Cal | $85 - $274 | 80% |
| Medi-Cal Healthnet | $85 - $274 | 80% |
| Medica | $85 - $274 | 80% |
| Medical Associates | $85 - $274 | 80% |
| Medical Benefits Mutual | $85 - $274 | 80% |
| Medical Mutual | $85 - $274 | 80% |
| Medical Office Monastery Of The Holy Cross | $85 - $274 | 80% |
| Medico | $85 - $274 | 80% |
| Medipak Advantage | $85 - $274 | 80% |
| Mediplus | $85 - $274 | 80% |
| Medstar Commercial | $85 - $274 | 80% |
| Medstar Dc Healthy Family | $85 - $274 | 80% |
| Medstar Md Health Choice | $85 - $274 | 80% |
| Memorial Integrated Health | $85 - $274 | 80% |
| Mercy Health Saint Marys Home | $85 - $274 | 80% |
| Mercy Infusion Pharmacy Ia Thhs | $85 - $274 | 80% |
| Mercy Life | $85 - $274 | 80% |
| Mercycare | $85 - $274 | 80% |
| Mercyone Cedar Valley | $85 - $274 | 80% |
| Meridian | $85 - $274 | 80% |
| Meridian Complete | $85 - $274 | 80% |
| Mes Solutions | $85 - $274 | 80% |
| Metlife | $85 - $274 | 80% |
| Metro Infectious Disease Consultants Infusion | $85 - $274 | 80% |
| Metroplus | $85 - $274 | 80% |
| Mhnet | $85 - $274 | 80% |
| Michigan Complete Health | $85 - $274 | 80% |
| Midlands | $85 - $274 | 80% |
| Midlands Choice | $85 - $274 | 80% |
| Midwest Group Benefits | $85 - $274 | 80% |
| Midwest- Operating Engineers | $85 - $274 | 80% |
| Minnesota Medica | $85 - $274 | 80% |
| Mo Home State Health Plan | $85 - $274 | 80% |
| Moda Health | $85 - $274 | 80% |
| Molina Centennial Care | $85 - $274 | 80% |
| Molina Marketplace | $85 - $274 | 80% |
| Morgan White Administrators | $85 - $274 | 80% |
| Mount Carmel Occupational Health | $85 - $274 | 80% |
| Mountain Health Co-Op | $85 - $274 | 80% |
| Mpn | $85 - $274 | 80% |
| Ms Administrative Services | $85 - $274 | 80% |
| Multiplan | $85 - $1,241 | 80% |
| Municipal Health | $85 - $274 | 80% |
| Muskegon County Jail | $85 - $274 | 80% |
| Mutual Health Services | $85 - $274 | 80% |
| Mutual Medical | $85 - $274 | 80% |
| Mutual Of Omaha | $85 - $274 | 80% |
| Mvp | $85 - $369 | 80% |
| Naphcare | $85 - $274 | 80% |
| Naphcare Correctional | $85 - $274 | 80% |
| Nascentia Health (Vna) | $85 - $274 | 80% |
| Nascentia Health Plus | $85 - $274 | 80% |
| National Elevator Health Benefit | $85 - $274 | 80% |
| National Healthcare Solutions | $85 - $274 | 80% |
| National Marrow Donor Program | $85 - $274 | 80% |
| Native American | $85 - $274 | 80% |
| Navigere | $85 - $274 | 80% |
| Ncas | $85 - $274 | 80% |
| Nebraska Total Care | $85 - $274 | 80% |
| Network Health | $85 - $274 | 80% |
| New Avenues | $85 - $274 | 80% |
| New Centry Health Careplus | $85 - $274 | 80% |
| New Courtland Life Program | $85 - $274 | 80% |
| New England Life | $85 - $274 | 80% |
| New York Cancer Services Program | $85 - $274 | 80% |
| New York Central Mutual Fire Insurance | $85 - $274 | 80% |
| New York State Dept Of Corrections | $85 - $274 | 80% |
| New York State Dept Of Health | $85 - $274 | 80% |
| New York State Doh Refugee Program | $85 - $274 | 80% |
| New York State Insurance Fund | $85 - $274 | 80% |
| Newton Correctional Facility | $85 - $274 | 80% |
| Nextlevel Health | $85 - $274 | 80% |
| Nippon Life Ins | $85 - $274 | 80% |
| Njm Insurance Group | $85 - $274 | 80% |
| Nomi Health | $85 - $274 | 80% |
| North American Administrators | $85 - $274 | 80% |
| Northeast Health District | $85 - $274 | 80% |
| Notre Dame Athletic Association | $85 - $274 | 80% |
| Nova | $85 - $896 | 80% |
| Novanet | $85 - $274 | 80% |
| Nys Dept Of Civil Services | $85 - $274 | 80% |
| Ohio Health Choice | $85 - $274 | 80% |
| Ohio Law Enforcement | $85 - $274 | 80% |
| Ohio Ppo Connect | $85 - $274 | 80% |
| Ohio Ryan White Program | $85 - $274 | 80% |
| Ohio Safe Program | $85 - $274 | 80% |
| Ohiohealthy | $85 - $274 | 80% |
| Olympus Managed Health Care | $85 - $274 | 80% |
| Oneida Tribe Of Indians | $85 - $274 | 80% |
| Operating Engineers | $85 - $274 | 80% |
| Optima Health | $85 - $274 | 80% |
| Orchid Medical | $85 - $274 | 80% |
| Oregon Screenwise | $85 - $274 | 80% |
| Oscar | $85 - $274 | 80% |
| Osu Not Independent Choice | $85 - $274 | 80% |
| Osu Prime Care Advantage | $85 - $274 | 80% |
| Ovag International Claims | $85 - $274 | 80% |
| Pace Cny | $85 - $274 | 80% |
| Pace Iowa Immanuel Pathways | $85 - $274 | 80% |
| Pace Of Southwest Michigan | $85 - $274 | 80% |
| Pace Southeast | $85 - $274 | 80% |
| Pace-Trinity Health | $85 - $274 | 80% |
| Pacificsource Health Plans | $85 - $274 | 80% |
| Pai | $85 - $274 | 80% |
| Painters Union Insurance Fund | $85 - $274 | 80% |
| Pan-American Life | $85 - $274 | 80% |
| Paramount Advantage | $85 - $274 | 80% |
| Paramount Hmo | $85 - $274 | 80% |
| Parkland Community Health Plan | $85 - $274 | 80% |
| Partners Behavioral Lme | $85 - $274 | 80% |
| Partners Direct Health - Brio | $85 - $274 | 80% |
| Peach State Healthplan | $85 - $274 | 80% |
| Peak Pace Solutions | $85 - $274 | 80% |
| Pehp Utah Public Employee Health Plan | $85 - $274 | 80% |
| Pekin | $85 - $274 | 80% |
| Penfield Care | $85 - $274 | 80% |
| Perennial Advantage | $85 - $274 | 80% |
| Phcs | $85 - $1,241 | 80% |
| Philadelphia American Life Insurance | $85 - $274 | 80% |
| Philadelphia County Funding | $85 - $274 | 80% |
| Phoenix Mutual | $85 - $274 | 80% |
| Physicians Health Plan Northern Indiana Health Insurance | $85 - $274 | 80% |
| Physicians Mutual | $85 - $274 | 80% |
| Physicians Plus | $85 - $274 | 80% |
| Pine Haven Home | $85 - $274 | 80% |
| Plain Church Group | $85 - $274 | 80% |
| Plumbers Local 98 Insurance Fund | $85 - $274 | 80% |
| Point Comfort Underwriters | $85 - $274 | 80% |
| Pokagon Band Of Potawatom | $85 - $274 | 80% |
| Poor Handmaids Of Jesus Christ | $85 - $274 | 80% |
| Prairie States | $85 - $274 | 80% |
| Pre-Employment | $85 - $274 | 80% |
| Preferred Care Partners | $85 - $274 | 80% |
| Preferred Health Choice | $85 - $274 | 80% |
| Preferred Network Access | $85 - $274 | 80% |
| Preferred One | $85 - $274 | 80% |
| Presbyterian Centennial Care | $85 - $274 | 80% |
| Presbyterian Senior Plan | $85 - $274 | 80% |
| Prestige Health Choice | $85 - $274 | 80% |
| Prevea 360 | $85 - $274 | 80% |
| Primary Physician Care | $85 - $274 | 80% |
| Prime Health Services | $85 - $274 | 80% |
| Prime Healthcare | $85 - $274 | 80% |
| Principal Life Insurance | $85 - $274 | 80% |
| Priority Health | $85 - $384 | 80% |
| Priority Partners | $85 - $274 | 80% |
| Proctor Preferred | $85 - $274 | 80% |
| Professional Benefit Administrators | $85 - $274 | 80% |
| Providence | $85 - $274 | 80% |
| Provider Partners Health Plan Of Illinois | $85 - $274 | 80% |
| Provider Partners Health Plan Of Indiana | $85 - $274 | 80% |
| Pruitthealth Premier | $85 - $274 | 80% |
| Psyhealth Bh | $85 - $274 | 80% |
| Qualcare | $85 - $274 | 80% |
| Quality Care Partners | $85 - $274 | 80% |
| Quality Correctional Care | $85 - $274 | 80% |
| Quality Health Management | $85 - $274 | 80% |
| Quiktrip | $85 - $274 | 80% |
| Reedman Toll | $85 - $274 | 80% |
| Reliance Community Care Partners Care Resources Pace | $85 - $274 | 80% |
| Reliastar | $85 - $274 | 80% |
| Rensselaer County Jail | $85 - $274 | 80% |
| Reserve National | $85 - $274 | 80% |
| Riveredge | $85 - $274 | 80% |
| Riverside Benefit Ipn | $85 - $274 | 80% |
| Riverside Center Rehab & Nursing | $85 - $274 | 80% |
| Robert F Sing Program | $85 - $274 | 80% |
| Rosewood Rehabilitation | $85 - $274 | 80% |
| Rural Carrier Health Benefit Plan | $85 - $274 | 80% |
| Rx 340B Pass Along | $85 - $274 | 80% |
| Rx Abacus Rx | $85 - $274 | 80% |
| Rx Abarca | $85 - $274 | 80% |
| Rx Advantage Solutions | $85 - $274 | 80% |
| Rx Agelity | $85 - $274 | 80% |
| Rx Aldot | $85 - $274 | 80% |
| Rx Alius | $85 - $274 | 80% |
| Rx Allwin | $85 - $274 | 80% |
| Rx Alpha Script | $85 - $274 | 80% |
| Rx American Health Care | $85 - $274 | 80% |
| Rx Amerihealth | $85 - $274 | 80% |
| Rx Amerisource | $85 - $274 | 80% |
| Rx Aps | $85 - $274 | 80% |
| Rx Aquinata Marywood | $85 - $274 | 80% |
| Rx Argus | $85 - $274 | 80% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $85 - $274 | 80% |
| Rx Asuris | $85 - $274 | 80% |
| Rx Auto | $85 - $274 | 80% |
| Rx Benecard Pbf | $85 - $274 | 80% |
| Rx Benescript | $85 - $274 | 80% |
| Rx Bestchoicerx | $85 - $274 | 80% |
| Rx Blue Care Network | $85 - $274 | 80% |
| Rx Bnrx | $85 - $274 | 80% |
| Rx Bridges Access | $85 - $274 | 80% |
| Rx Brownsville Ind School Dist | $85 - $274 | 80% |
| Rx Cadence | $85 - $274 | 80% |
| Rx Capital Rx | $85 - $274 | 80% |
| Rx Caremark | $85 - $274 | 80% |
| Rx Caremark M3P Program | $85 - $274 | 80% |
| Rx Castiarx | $85 - $274 | 80% |
| Rx Catamaran | $85 - $274 | 80% |
| Rx Century Healthcare | $85 - $274 | 80% |
| Rx Cerpassrx | $85 - $274 | 80% |
| Rx Champus | $85 - $274 | 80% |
| Rx Champva | $85 - $274 | 80% |
| Rx Change Healthcare | $85 - $274 | 80% |
| Rx Clearscript | $85 - $274 | 80% |
| Rx Cmh Discharge | $85 - $274 | 80% |
| Rx Columbia | $85 - $274 | 80% |
| Rx Comcotec | $85 - $274 | 80% |
| Rx Costco Health Solutions | $85 - $274 | 80% |
| Rx Crx | $85 - $274 | 80% |
| Rx Ct Assist | $85 - $274 | 80% |
| Rx Cypress Care | $85 - $274 | 80% |
| Rx Data Rx | $85 - $274 | 80% |
| Rx Data Rx Egentra | $85 - $274 | 80% |
| Rx Dean Health Plan | $85 - $274 | 80% |
| Rx Detroit Formulary | $85 - $274 | 80% |
| Rx Discount Card | $85 - $274 | 80% |
| Rx Dispensary Of Hope | $85 - $274 | 80% |
| Rx Eho | $85 - $274 | 80% |
| Rx Emdeon | $85 - $274 | 80% |
| Rx Empirx | $85 - $274 | 80% |
| Rx Envision Rx | $85 - $274 | 80% |
| Rx Epicash | $85 - $274 | 80% |
| Rx Evofirst | $85 - $274 | 80% |
| Rx Express Scripts | $85 - $274 | 80% |
| Rx Fallon Community Health | $85 - $274 | 80% |
| Rx First Fill Program | $85 - $274 | 80% |
| Rx First Health | $85 - $274 | 80% |
| Rx Flipt | $85 - $274 | 80% |
| Rx Future Scripts | $85 - $274 | 80% |
| Rx Gateway Health Plan | $85 - $274 | 80% |
| Rx General Dynamics | $85 - $274 | 80% |
| Rx Generic | $85 - $274 | 80% |
| Rx Gilead | $85 - $274 | 80% |
| Rx Grane Grnmedd | $85 - $274 | 80% |
| Rx Great West Healthcare | $85 - $274 | 80% |
| Rx Group Management Services | $85 - $274 | 80% |
| Rx Gunderson | $85 - $274 | 80% |
| Rx Hap | $85 - $274 | 80% |
| Rx Hap Mppp | $85 - $274 | 80% |
| Rx Harbor Homecare | $85 - $274 | 80% |
| Rx Hds | $85 - $274 | 80% |
| Rx Health Partners | $85 - $274 | 80% |
| Rx Health Plus | $85 - $274 | 80% |
| Rx Health Select | $85 - $274 | 80% |
| Rx Health Systems | $85 - $274 | 80% |
| Rx Healthe Systems | $85 - $274 | 80% |
| Rx Healthplan | $85 - $274 | 80% |
| Rx Healthtrans | $85 - $274 | 80% |
| Rx Heatlhcomp | $85 - $274 | 80% |
| Rx Hip | $85 - $274 | 80% |
| Rx Horizon Mercy | $85 - $274 | 80% |
| Rx Ideal Scripts | $85 - $274 | 80% |
| Rx Ihc | $85 - $274 | 80% |
| Rx Independent Health | $85 - $274 | 80% |
| Rx Informed Rx | $85 - $274 | 80% |
| Rx Inland Empire Health Plan | $85 - $274 | 80% |
| Rx Integrated Prescription Manage | $85 - $274 | 80% |
| Rx Iowa | $85 - $274 | 80% |
| Rx Laker Software | $85 - $274 | 80% |
| Rx Ldi | $85 - $274 | 80% |
| Rx Lipc/Mchp | $85 - $274 | 80% |
| Rx Lipc/Mchp Copay | $85 - $274 | 80% |
| Rx Lumenos | $85 - $274 | 80% |
| Rx Macro Helix 340B | $85 - $274 | 80% |
| Rx Magellan | $85 - $274 | 80% |
| Rx Maryland Adv | $85 - $274 | 80% |
| Rx Matrix | $85 - $274 | 80% |
| Rx Maxorplus | $85 - $274 | 80% |
| Rx Mcauley Clinic | $85 - $274 | 80% |
| Rx Mclaren Marketplace | $85 - $274 | 80% |
| Rx Medben | $85 - $274 | 80% |
| Rx Medco | $85 - $274 | 80% |
| Rx Mede America | $85 - $274 | 80% |
| Rx Medexus | $85 - $274 | 80% |
| Rx Medi-Cal | $85 - $274 | 80% |
| Rx Medimpact | $85 - $274 | 80% |
| Rx Medisource | $85 - $274 | 80% |
| Rx Medone Health Care | $85 - $274 | 80% |
| Rx Medtrak | $85 - $274 | 80% |
| Rx Mercycare | $85 - $274 | 80% |
| Rx Meridian Rx | $85 - $274 | 80% |
| Rx Metropolitan Health Plan | $85 - $274 | 80% |
| Rx Michigan Prescription Assistance | $85 - $274 | 80% |
| Rx Mrx | $85 - $274 | 80% |
| Rx Mutual Of Omaha | $85 - $274 | 80% |
| Rx National Script | $85 - $274 | 80% |
| Rx Navitus Health | $85 - $274 | 80% |
| Rx Net Rx | $85 - $274 | 80% |
| Rx Netcard Systems | $85 - $274 | 80% |
| Rx Netwell | $85 - $274 | 80% |
| Rx Nmhc | $85 - $274 | 80% |
| Rx Nps | $85 - $274 | 80% |
| Rx Ny Naloxone Copay | $85 - $274 | 80% |
| Rx Ohio Bwc | $85 - $274 | 80% |
| Rx Ohsu | $85 - $274 | 80% |
| Rx Optima | $85 - $274 | 80% |
| Rx Paper Claims | $85 - $274 | 80% |
| Rx Paramount Rx | $85 - $274 | 80% |
| Rx Partners Rx | $85 - $274 | 80% |
| Rx Patient Access Network | $85 - $274 | 80% |
| Rx Patient Support Program | $85 - $274 | 80% |
| Rx Payer Id | $85 - $274 | 80% |
| Rx Pbm | $85 - $274 | 80% |
| Rx Pcn | $85 - $274 | 80% |
| Rx Pdm | $85 - $274 | 80% |
| Rx Pdmi | $85 - $274 | 80% |
| Rx Pennsylvania Pace | $85 - $274 | 80% |
| Rx Perform | $85 - $274 | 80% |
| Rx Pharmacare | $85 - $274 | 80% |
| Rx Pharmacy Associates | $85 - $274 | 80% |
| Rx Pharmalink | $85 - $274 | 80% |
| Rx Pharmavail | $85 - $274 | 80% |
| Rx Pharmpix | $85 - $274 | 80% |
| Rx Physician Rx Care Discount | $85 - $274 | 80% |
| Rx Physicians Plus | $85 - $274 | 80% |
| Rx Pinnacle | $85 - $274 | 80% |
| Rx Preferredone | $85 - $274 | 80% |
| Rx Prescription Advantage | $85 - $274 | 80% |
| Rx Prime Therapeutics | $85 - $274 | 80% |
| Rx Prime Therapeutics State Government Solutions Llc | $85 - $274 | 80% |
| Rx Prior Auth Plus | $85 - $274 | 80% |
| Rx Proact | $85 - $274 | 80% |
| Rx Proact Rx | $85 - $274 | 80% |
| Rx Procare Rx | $85 - $274 | 80% |
| Rx Procella Health | $85 - $274 | 80% |
| Rx Promark | $85 - $274 | 80% |
| Rx Providence | $85 - $274 | 80% |
| Rx Providence Health Plan | $85 - $274 | 80% |
| Rx Ramsell Public Health Rx | $85 - $274 | 80% |
| Rx Regencerx | $85 - $274 | 80% |
| Rx Relayhealth | $85 - $274 | 80% |
| Rx Rems | $85 - $274 | 80% |
| Rx Restat | $85 - $274 | 80% |
| Rx Retiree Rx Care | $85 - $274 | 80% |
| Rx Rx Advance Commercial | $85 - $274 | 80% |
| Rx Rx America | $85 - $274 | 80% |
| Rx Rx Prime | $85 - $274 | 80% |
| Rx Rx Solution | $85 - $274 | 80% |
| Rx Saif Opdp Wc | $85 - $274 | 80% |
| Rx Savings | $85 - $274 | 80% |
| Rx Savrx Advantage | $85 - $274 | 80% |
| Rx Scott & White | $85 - $274 | 80% |
| Rx Script Card | $85 - $274 | 80% |
| Rx Scriptnet | $85 - $274 | 80% |
| Rx Security Health | $85 - $274 | 80% |
| Rx Select Health | $85 - $274 | 80% |
| Rx Serve You Rx | $85 - $274 | 80% |
| Rx Shp | $85 - $274 | 80% |
| Rx Singlecare | $85 - $274 | 80% |
| Rx Smithrx | $85 - $274 | 80% |
| Rx Southern Scripts | $85 - $274 | 80% |
| Rx Sxc | $85 - $274 | 80% |
| Rx Third Party Solutions | $85 - $274 | 80% |
| Rx Together Rx | $85 - $274 | 80% |
| Rx Total Script | $85 - $274 | 80% |
| Rx Transamerica | $85 - $274 | 80% |
| Rx Tredium | $85 - $274 | 80% |
| Rx Trialcard | $85 - $274 | 80% |
| Rx Triple S Salud | $85 - $274 | 80% |
| Rx True Rx | $85 - $274 | 80% |
| Rx Union Pacific | $85 - $274 | 80% |
| Rx Univeristy Of Utah Health | $85 - $274 | 80% |
| Rx Unknown | $85 - $274 | 80% |
| Rx Us Script | $85 - $274 | 80% |
| Rx Value Rx | $85 - $274 | 80% |
| Rx Valuscript | $85 - $274 | 80% |
| Rx Vault Admin Svcs | $85 - $274 | 80% |
| Rx Ventegra | $85 - $274 | 80% |
| Rx Voucher | $85 - $274 | 80% |
| Rx Vrx | $85 - $274 | 80% |
| Rx Wabash | $85 - $274 | 80% |
| Rx Wausau | $85 - $274 | 80% |
| Rx Worker'S Comp | $85 - $274 | 80% |
| Rx Yes | $85 - $274 | 80% |
| Ryan White Florida Mssrp | $85 - $274 | 80% |
| Sagamore Health Network | $85 - $274 | 80% |
| Saint Alphonsus Rehab Hospital | $85 - $274 | 80% |
| Saint Francis Hospital And Medical Center Occupation Health | $85 - $274 | 80% |
| Saint Francis Life | $85 - $274 | 80% |
| Saint Pius X | $85 - $274 | 80% |
| Sandhills Center Lme | $85 - $274 | 80% |
| Sanford Health Plan | $85 - $274 | 80% |
| Sanus Healthcare | $85 - $274 | 80% |
| Saratoga Center For Rehab & Snc | $85 - $274 | 80% |
| Scan Health Plan Mcr Ipa Meritage Oon | $85 - $274 | 80% |
| Screening For Life | $85 - $274 | 80% |
| Screening For Life - Delaware | $85 - $274 | 80% |
| Secura Insurance | $85 - $274 | 80% |
| Secure Horizons Ma Pffs | $85 - $274 | 80% |
| Secureone Preferred United Plans | $85 - $274 | 80% |
| Security Administrative Services - Indiana | $85 - $274 | 80% |
| Security Health Plan | $85 - $274 | 80% |
| Selectcare Worldwide | $85 - $274 | 80% |
| Selecthealth | $85 - $274 | 80% |
| Self Insured Services Co | $85 - $274 | 80% |
| Serenity Pace | $85 - $274 | 80% |
| Signature Care | $85 - $274 | 80% |
| Siho Insurance Services | $85 - $274 | 80% |
| Silver Lake Nursing & Rehab Center | $85 - $274 | 80% |
| Siouxland Pace | $85 - $274 | 80% |
| Sisco Benefits | $85 - $274 | 80% |
| Solis Health Plans | $85 - $274 | 80% |
| Southern Benefits | $85 - $274 | 80% |
| St Agnes Nicu Valley Childrens Hospital | $85 - $274 | 80% |
| St Joseph Aa Hit Thhs | $85 - $274 | 80% |
| St Joseph County Hlth Dpt | $85 - $274 | 80% |
| St Lukes Health Plan | $85 - $274 | 80% |
| St Mary Rehab Hospital Ll | $85 - $274 | 80% |
| Star Healthcare Network | $85 - $274 | 80% |
| State Farm Health | $85 - $274 | 80% |
| State Mutual Ins Co | $85 - $274 | 80% |
| State Of Illinois Disability | $85 - $274 | 80% |
| Stellar Healthscope Benefits | $85 - $274 | 80% |
| Stephenson Cty Health | $85 - $274 | 80% |
| Stirling Benefits | $85 - $274 | 80% |
| Student Insurance Cma | $85 - $274 | 80% |
| Sunbelt International | $85 - $274 | 80% |
| Sunlife Financial | $85 - $274 | 80% |
| Sunmed International | $85 - $274 | 80% |
| Sunnyview-Pace Finance Dept | $85 - $274 | 80% |
| Sunshine State Health Plan | $85 - $274 | 80% |
| Superior Health | $85 - $274 | 80% |
| Superior Vision | $85 - $274 | 80% |
| Superior Woods Skilled Nursing Facility | $85 - $274 | 80% |
| Temple University Health Systems | $85 - $274 | 80% |
| Tenncare | $85 - $274 | 80% |
| Teresian House | $85 - $274 | 80% |
| Texan Plus | $85 - $274 | 80% |
| Texas Children'S Health Plan | $85 - $274 | 80% |
| Th Experian Coverage Discovery | $85 - $274 | 80% |
| The Alliance | $85 - $274 | 80% |
| The Health Plan | $85 - $274 | 80% |
| The Loomis Company | $85 - $274 | 80% |
| The Springs Nursing & Rehab | $85 - $274 | 80% |
| Theramatrix Physical Therapy Network | $85 - $274 | 80% |
| Therapy Network Of Georgia | $85 - $274 | 80% |
| Thome Pace | $85 - $274 | 80% |
| Three Rivers Provider Network | $85 - $274 | 80% |
| Thrivent | $85 - $274 | 80% |
| Todays Options | $85 - $274 | 80% |
| Together With Childrens Comminity Health Plan | $85 - $274 | 80% |
| Total Health Care | $85 - $274 | 80% |
| Town Of East Hartford | $85 - $274 | 80% |
| Town Of West Hartford | $85 - $274 | 80% |
| Transamerica | $85 - $274 | 80% |
| Tribute Health Plans | $85 - $274 | 80% |
| Trillium Community Ohp | $85 - $274 | 80% |
| Trilogy | $85 - $274 | 80% |
| Trinity Health Of New England At Home | $85 - $274 | 80% |
| Trinity Health Share | $85 - $274 | 80% |
| Tristar Lyons Magnus | $85 - $274 | 80% |
| True Health New Mexico | $85 - $274 | 80% |
| Trustbridge | $85 - $274 | 80% |
| Trustmark Small Business Benefits | $85 - $274 | 80% |
| Tufts Health Plan | $85 - $384 | 80% |
| Tufts Health Public Plans | $85 - $274 | 80% |
| Twin Valley Psychiatric | $85 - $274 | 80% |
| Twining Village Nursing Home | $85 - $274 | 80% |
| U Of M Health Plan | $85 - $274 | 80% |
| Ucare | $85 - $274 | 80% |
| Ufcw Local 1546 | $85 - $274 | 80% |
| Um Health Advantage | $85 - $274 | 80% |
| Unicare | $85 - $300 | 80% |
| Unified Group Services | $85 - $274 | 80% |
| Union Health Service | $85 - $274 | 80% |
| Union Pacific Railroad Employee Health Systems | $85 - $274 | 80% |
| United American Insurance | $85 - $274 | 80% |
| United Behavioral Health Eap | $85 - $274 | 80% |
| United Commercial Travelers | $85 - $274 | 80% |
| United Mine Workers | $85 - $274 | 80% |
| United States Life Ins Co | $85 - $274 | 80% |
| Unity | $85 - $274 | 80% |
| University Of Il Campus Care | $85 - $274 | 80% |
| Upmc Health Plan | $85 - $274 | 80% |
| Us Health And Life | $85 - $274 | 80% |
| Us Lab | $85 - $274 | 80% |
| Us Probation Pretrial Services | $85 - $274 | 80% |
| Usa Managed Care | $85 - $274 | 80% |
| Usaa Life Insurance Company | $85 - $274 | 80% |
| Utah Idaho Teamsters Security Fund | $85 - $274 | 80% |
| Utica National Insurance Group | $85 - $274 | 80% |
| Valenz | $85 - $274 | 80% |
| Van Rensselaer Manor | $85 - $274 | 80% |
| Varipro | $85 - $274 | 80% |
| Vaya Health Lme | $85 - $274 | 80% |
| Velocity | $85 - $274 | 80% |
| Versant Health | $85 - $274 | 80% |
| Vestica | $85 - $274 | 80% |
| Vision Service Plan | $85 - $274 | 80% |
| Vitalcore | $85 - $274 | 80% |
| Vitas Healthcare Corp | $85 - $274 | 80% |
| Vna Hospice | $85 - $274 | 80% |
| Washtenaw Health Plan | $85 - $274 | 80% |
| Wayne County Healthchoice | $85 - $274 | 80% |
| Wc Accident Fund | $85 - $274 | 80% |
| Wc Ace | $85 - $274 | 80% |
| Wc Acs Federal Employees | $85 - $274 | 80% |
| Wc Acuity | $85 - $274 | 80% |
| Wc Advantage | $85 - $274 | 80% |
| Wc Aegis | $85 - $274 | 80% |
| Wc Aig | $85 - $274 | 80% |
| Wc Aims | $85 - $274 | 80% |
| Wc Alaska National Ins | $85 - $274 | 80% |
| Wc Align Network | $85 - $274 | 80% |
| Wc Allied | $85 - $274 | 80% |
| Wc Am Trust N America | $85 - $274 | 80% |
| Wc American Claims Mgmt | $85 - $274 | 80% |
| Wc Amerisure | $85 - $274 | 80% |
| Wc Amtrust | $85 - $274 | 80% |
| Wc Asu Risk Mgt | $85 - $274 | 80% |
| Wc Benetech | $85 - $274 | 80% |
| Wc Berkley Admin | $85 - $274 | 80% |
| Wc Broadspire | $85 - $274 | 80% |
| Wc Broward County | $85 - $274 | 80% |
| Wc Bunch & Associates | $85 - $274 | 80% |
| Wc California State Comp Ins | $85 - $274 | 80% |
| Wc California State Ins Fund | $85 - $274 | 80% |
| Wc Capitol Area Health Consortium | $85 - $274 | 80% |
| Wc Ccmsi | $85 - $274 | 80% |
| Wc Chartis | $85 - $274 | 80% |
| Wc Chubb | $85 - $274 | 80% |
| Wc Cirma | $85 - $274 | 80% |
| Wc City Of Albany | $85 - $274 | 80% |
| Wc City Of Sioux City | $85 - $274 | 80% |
| Wc Claims Mgmt Inc | $85 - $274 | 80% |
| Wc Cna | $85 - $274 | 80% |
| Wc Comp One Admin C/O Manageability | $85 - $274 | 80% |
| Wc Compone Admin | $85 - $274 | 80% |
| Wc Corvel | $85 - $274 | 80% |
| Wc Ct Healthcare Trust | $85 - $274 | 80% |
| Wc Domestic | $85 - $274 | 80% |
| Wc Donegal Insurance Group | $85 - $274 | 80% |
| Wc Emc Insurance Company | $85 - $274 | 80% |
| Wc Employee Mutual | $85 - $274 | 80% |
| Wc Enablecomp | $85 - $274 | 80% |
| Wc Encore Health Network | $85 - $274 | 80% |
| Wc Erie | $85 - $274 | 80% |
| Wc Esis | $85 - $274 | 80% |
| Wc Evolutions | $85 - $274 | 80% |
| Wc Fcci | $85 - $274 | 80% |
| Wc Fed Ex | $85 - $274 | 80% |
| Wc Federal Black Lung | $85 - $274 | 80% |
| Wc Federated | $85 - $274 | 80% |
| Wc Finley Occupational Health | $85 - $274 | 80% |
| Wc First Agency/Occunet | $85 - $274 | 80% |
| Wc Ford Motor | $85 - $274 | 80% |
| Wc Fresno Unified Emp | $85 - $274 | 80% |
| Wc Gallagher Bassett | $85 - $274 | 80% |
| Wc General Motors | $85 - $274 | 80% |
| Wc Generic | $85 - $115 | 80% |
| Wc Genex Care For Ohio | $85 - $274 | 80% |
| Wc Great West Casualty | $85 - $274 | 80% |
| Wc Guarantee Insurance | $85 - $274 | 80% |
| Wc Guard Insurance Company | $85 - $274 | 80% |
| Wc Hab | $85 - $274 | 80% |
| Wc Hartford | $85 - $274 | 80% |
| Wc Hastings | $85 - $274 | 80% |
| Wc Health Management | $85 - $274 | 80% |
| Wc Heritage Summit | $85 - $274 | 80% |
| Wc Hireright | $85 - $274 | 80% |
| Wc Horizon | $85 - $274 | 80% |
| Wc Icw Group | $85 - $274 | 80% |
| Wc Idaho State Ins Fund | $85 - $274 | 80% |
| Wc Intercare Insurance | $85 - $274 | 80% |
| Wc Intermountain | $85 - $274 | 80% |
| Wc Johns Eastern | $85 - $274 | 80% |
| Wc Kemberton | $85 - $274 | 80% |
| Wc Key Ins & Benefit Solutions | $85 - $274 | 80% |
| Wc Liberty Mutual | $85 - $274 | 80% |
| Wc Mac Risk Management | $85 - $274 | 80% |
| Wc Massachusetts | $85 - $274 | 80% |
| Wc Mdia | $85 - $274 | 80% |
| Wc Meadowbrook Claim | $85 - $274 | 80% |
| Wc Medical Administrators | $85 - $274 | 80% |
| Wc Meijers | $85 - $274 | 80% |
| Wc Memic | $85 - $274 | 80% |
| Wc Mercy Workcare | $85 - $274 | 80% |
| Wc Michigan | $85 - $274 | 80% |
| Wc Michigan Millers Mutual | $85 - $274 | 80% |
| Wc Mitchell Frankenmuth | $85 - $274 | 80% |
| Wc Mra | $85 - $274 | 80% |
| Wc Nationwide | $85 - $274 | 80% |
| Wc Nca Comp | $85 - $274 | 80% |
| Wc New York | $85 - $274 | 80% |
| Wc New York Special Funds | $85 - $274 | 80% |
| Wc North American Rishces | $85 - $274 | 80% |
| Wc Northeast Health | $85 - $274 | 80% |
| Wc Notre Dame | $85 - $274 | 80% |
| Wc Novanet | $85 - $274 | 80% |
| Wc O'Hara Corp | $85 - $274 | 80% |
| Wc Occ Health Allen | $85 - $274 | 80% |
| Wc Ohio Bureau | $85 - $274 | 80% |
| Wc One Call Medical | $85 - $274 | 80% |
| Wc Paradigm | $85 - $274 | 80% |
| Wc Peerless | $85 - $274 | 80% |
| Wc Pma | $85 - $274 | 80% |
| Wc Praxis Health Network | $85 - $274 | 80% |
| Wc Price Chopper | $85 - $274 | 80% |
| Wc Procura Management | $85 - $274 | 80% |
| Wc Qualcare | $85 - $274 | 80% |
| Wc Quiktrip | $85 - $274 | 80% |
| Wc Reny Company | $85 - $274 | 80% |
| Wc Rev Claims | $85 - $274 | 80% |
| Wc Risico | $85 - $274 | 80% |
| Wc Rural Mutual | $85 - $274 | 80% |
| Wc Saif Oregon | $85 - $274 | 80% |
| Wc Secura | $85 - $274 | 80% |
| Wc Sedgwick | $85 - $274 | 80% |
| Wc Sentry | $85 - $274 | 80% |
| Wc Sheakley Unicomp | $85 - $274 | 80% |
| Wc Smile Lodge | $85 - $274 | 80% |
| Wc Society | $85 - $274 | 80% |
| Wc Srs | $85 - $274 | 80% |
| Wc Taconic (Mro) | $85 - $274 | 80% |
| Wc Taconic Farms | $85 - $274 | 80% |
| Wc Travelers | $85 - $274 | 80% |
| Wc Triad Group | $85 - $274 | 80% |
| Wc Tristar | $85 - $274 | 80% |
| Wc Troy Ny | $85 - $274 | 80% |
| Wc Tyson | $85 - $274 | 80% |
| Wc Unified Health Services | $85 - $274 | 80% |
| Wc United Heartland | $85 - $274 | 80% |
| Wc Us Dept Of Labor | $85 - $274 | 80% |
| Wc Velocity | $85 - $274 | 80% |
| Wc Walmart | $85 - $274 | 80% |
| Wc West Bend | $85 - $274 | 80% |
| Wc West Bend Mutual/Argent | $85 - $274 | 80% |
| Wc Winnebago Industries | $85 - $274 | 80% |
| Wc Yankee Trails | $85 - $274 | 80% |
| Wc York Risk | $85 - $274 | 80% |
| Wc Zenith | $85 - $274 | 80% |
| Wc Zurich | $85 - $274 | 80% |
| Wea | $85 - $274 | 80% |
| Webtpa | $85 - $384 | 80% |
| Welbe Health | $85 - $274 | 80% |
| Wellmed | $85 - $274 | 80% |
| Wellpath | $85 - $294 | 80% |
| Wellpoint | $85 - $274 | 80% |
| Wellpoint Maryland | $85 - $274 | 80% |
| Wellsense Health Plan | $85 - $274 | 80% |
| Western & Southern Financial Group | $85 - $274 | 80% |
| Wexford Health | $85 - $274 | 80% |
| Whittier Health | $85 - $274 | 80% |
| Wi Laborers | $85 - $274 | 80% |
| Wi Womens Wellness | $85 - $274 | 80% |
| Wisconsin Labor Union | $85 - $274 | 80% |
| Wps | $85 - $274 | 80% |
| Ww Concierge Healthcare Service | $85 - $274 | 80% |
| Yardley-Makefield Firemen'S Relief Association | $85 - $274 | 80% |