CMS Price Transparency Data
Gallbladder removal (laparoscopic)
Facility: Saint Alphonsus Medical Center Ontario
Billing Code: 47562 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 47562
- Insurance Median: $171
- Cash Discount Price: $416
- vs. Medicare Baseline: 0.03x Medicare
The contracted insurance negotiated median rate for a Gallbladder removal (laparoscopic) at Saint Alphonsus Medical Center Ontario is $171. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $416. Compared to the federal Medicare reimbursement reference rate of $6,176.47, this hospital’s rate is 0.03x the Medicare baseline. Located in 351 Sw 9Th Street, Ontario, OR.
Cash / Self-Pay
$416
Average discount available for prompt cash payment at this facility.
Insurance Median
$171
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$6,176.47
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $6,176.47 (100%)
Cash / Self-Pay: $416 (7%)
Insurance Median: $171 (3%)
Cash: $416 (7% of Medicare)
Ins. Median: $171 (3% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $6,176.47 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 |
|---|---|---|
| Bcn Domestic | $68 - $676 | 1% |
| Blue Benefit Administrators Of Massachusetts | $68 - $676 | 1% |
| Blue Care Network | $68 - $676 | 1% |
| Blue Cross Blue Shield | $68 - $676 | 1% |
| Blue Distinction Transplant | $68 - $676 | 1% |
| Blue Shield - Ca | $68 - $676 | 1% |
| Blue Shield - Id (Regence) | $68 - $703 | 1% |
| Blue Shield - Ny Highmark Northeastern | $68 - $676 | 1% |
| Blue Shield - Ny Highmark Western | $68 - $676 | 1% |
| Blue Shield - Pa (Highmark) | $68 - $676 | 1% |
| Blue Shield - Wa (Regence) | $68 - $676 | 1% |
| Health Choices | $68 - $676 | 1% |
| Kaiser Domestic | $68 - $676 | 1% |
| Pre-Employment | $68 - $676 | 1% |
| Wc Domestic | $68 - $676 | 1% |
| Asuris Northwest Health | $70 - $703 | 1% |
| Healthcare Management Admin | $70 - $703 | 1% |
| Aetna | $80 - $857 | 1% |
| Meritain | $80 - $499 | 1% |
| Albany County Correctional Facility | $82 - $513 | 1% |
| Ambetter / Centene | $82 - $513 | 1% |
| Amish Mennonite | $82 - $513 | 1% |
| Ascension St. Vincent Public Safety Medical | $82 - $513 | 1% |
| Bcccp-Michigan | $82 - $513 | 1% |
| Bccp | $82 - $513 | 1% |
| Bmc Healthnet | $82 - $513 | 1% |
| Breast Grant-Connecticut | $82 - $513 | 1% |
| Broward County Dept Of Health | $82 - $513 | 1% |
| California Health And Wellness | $82 - $513 | 1% |
| Can Community Health Inc | $82 - $513 | 1% |
| Cardinal Innovations Lme | $82 - $513 | 1% |
| Care Connections Of Northern Iowa | $82 - $513 | 1% |
| Care Oregon Ohp | $82 - $513 | 1% |
| Cencal Health Plan | $82 - $513 | 1% |
| Cenpatico | $82 - $513 | 1% |
| Chhuny | $82 - $513 | 1% |
| Childrens Comm Health Plan | $82 - $513 | 1% |
| Childrens Medical Services Title 19 | $82 - $513 | 1% |
| Cigna | $82 - $542 | 1% |
| City Of Philadelphia | $82 - $513 | 1% |
| Cmh Allegan County | $82 - $513 | 1% |
| Cmh Ausable Valley | $82 - $513 | 1% |
| Cmh Barry County | $82 - $513 | 1% |
| Cmh Bay-Arenac County | $82 - $513 | 1% |
| Cmh Berrien County | $82 - $513 | 1% |
| Cmh Cass County | $82 - $513 | 1% |
| Cmh Central Mi County | $82 - $513 | 1% |
| Cmh Clinton-Eaton-Ingham County | $82 - $513 | 1% |
| Cmh Detroit Wayne Integrated Health Network | $82 - $513 | 1% |
| Cmh Genesee County | $82 - $513 | 1% |
| Cmh Ionia County | $82 - $513 | 1% |
| Cmh Jackson County/Lifeways | $82 - $513 | 1% |
| Cmh Kalamazoo | $82 - $513 | 1% |
| Cmh Kent County | $82 - $513 | 1% |
| Cmh Lenawee County | $82 - $513 | 1% |
| Cmh Livingston County | $82 - $513 | 1% |
| Cmh Macomb | $82 - $513 | 1% |
| Cmh Misc | $82 - $513 | 1% |
| Cmh Monroe County | $82 - $513 | 1% |
| Cmh Montcalm County | $82 - $513 | 1% |
| Cmh Muskegon County | $82 - $513 | 1% |
| Cmh Newaygo County | $82 - $513 | 1% |
| Cmh North Country | $82 - $513 | 1% |
| Cmh Northern Lakes County | $82 - $513 | 1% |
| Cmh Oakland County | $82 - $513 | 1% |
| Cmh Ottawa County | $82 - $513 | 1% |
| Cmh Van Buren County | $82 - $513 | 1% |
| Cmh Washtenaw County | $82 - $513 | 1% |
| Cmh Wayne County/Carelink | $82 - $513 | 1% |
| Cmh Wayne Cty/Com Liv Svcs | $82 - $513 | 1% |
| Cmh West Mi County | $82 - $513 | 1% |
| Community Benefit Health | $82 - $513 | 1% |
| Community Care Behavorial Health | $82 - $513 | 1% |
| Community Care Partners | $82 - $513 | 1% |
| Community Health Choice | $82 - $513 | 1% |
| Connections Csp | $82 - $513 | 1% |
| County Coroner | $82 - $513 | 1% |
| County Funding Generic | $82 - $513 | 1% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $82 - $513 | 1% |
| Dean Wi Badgercare | $82 - $513 | 1% |
| Delaware County Department Of Health | $82 - $513 | 1% |
| Delaware First Health | $82 - $513 | 1% |
| Delta Dental Nj | $82 - $513 | 1% |
| Dph Tb Program | $82 - $513 | 1% |
| Dscc | $82 - $513 | 1% |
| Eastpointe Lme | $82 - $513 | 1% |
| Family Health Network | $82 - $513 | 1% |
| Freedom First Healthcare | $82 - $513 | 1% |
| Fresno County Ccs | $82 - $513 | 1% |
| Ghc Scw Wi Badgercare | $82 - $513 | 1% |
| Harbor Health | $82 - $513 | 1% |
| Health Safety Net | $82 - $513 | 1% |
| Healthy Blue Ne | $82 - $513 | 1% |
| Hennepin Health | $82 - $513 | 1% |
| Humana | $82 - $1,464 | 1% |
| Id County Ada | $82 - $513 | 1% |
| Id County Canyon | $82 - $513 | 1% |
| Id County Cat Fund | $82 - $513 | 1% |
| Id County Other | $82 - $513 | 1% |
| Id County Payette | $82 - $513 | 1% |
| Idaho Dept Health And Wellfare | $82 - $513 | 1% |
| Idaho Womens Health Check | $82 - $513 | 1% |
| Indiana Breast Cervical Cancer | $82 - $513 | 1% |
| Inland Empire Health Plan | $82 - $513 | 1% |
| Intercommunity Health Ohp | $82 - $513 | 1% |
| Iowa Total Care | $82 - $513 | 1% |
| Jai Medical System | $82 - $513 | 1% |
| Kern Family Health Plan | $82 - $513 | 1% |
| Keystone First | $82 - $513 | 1% |
| Keystone First Chip | $82 - $513 | 1% |
| La Care Health Plan | $82 - $513 | 1% |
| Lakeland Care Inc | $82 - $513 | 1% |
| Managed Health Services - Indiana | $82 - $513 | 1% |
| Maryland Breast & Cervical Program | $82 - $513 | 1% |
| Maryland Healthy Smiles - Scion Dental | $82 - $513 | 1% |
| Maryland Physicians Care | $82 - $513 | 1% |
| Massachusetts Behavioral Health Partnership | $82 - $513 | 1% |
| Mdwise | $82 - $513 | 1% |
| Medi-Cal | $82 - $513 | 1% |
| Medi-Cal Healthnet | $82 - $513 | 1% |
| Medicaid / KanCare | $82 - $1,299 | 1% |
| Medstar Dc Healthy Family | $82 - $513 | 1% |
| Medstar Md Health Choice | $82 - $513 | 1% |
| Mo Home State Health Plan | $82 - $513 | 1% |
| Molina Centennial Care | $82 - $513 | 1% |
| Nascentia Health Options | $82 - $513 | 1% |
| Nebraska Total Care | $82 - $513 | 1% |
| New York Cancer Services Program | $82 - $513 | 1% |
| Nextlevel Health | $82 - $513 | 1% |
| Pace Of Southwest Michigan | $82 - $513 | 1% |
| Paramount Advantage | $82 - $513 | 1% |
| Parkland Community Health Plan | $82 - $513 | 1% |
| Partners Behavioral Lme | $82 - $513 | 1% |
| Peach State Healthplan | $82 - $513 | 1% |
| Philadelphia County Funding | $82 - $513 | 1% |
| Presbyterian Centennial Care | $82 - $513 | 1% |
| Prestige Health Choice | $82 - $513 | 1% |
| Priority Partners | $82 - $513 | 1% |
| Robert F Sing Program | $82 - $513 | 1% |
| Rx 340B Pass Along | $82 - $513 | 1% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $82 - $513 | 1% |
| Rx Medi-Cal | $82 - $513 | 1% |
| Rx Meridian Rx | $82 - $513 | 1% |
| Ryan White Florida Mssrp | $82 - $513 | 1% |
| Sandhills Center Lme | $82 - $513 | 1% |
| Screening For Life | $82 - $513 | 1% |
| St Joseph County Hlth Dpt | $82 - $513 | 1% |
| Stephenson Cty Health | $82 - $513 | 1% |
| Sunshine State Health Plan | $82 - $513 | 1% |
| Superior Health | $82 - $513 | 1% |
| Tenncare | $82 - $513 | 1% |
| Texas Children'S Health Plan | $82 - $513 | 1% |
| Trillium Community Ohp | $82 - $513 | 1% |
| Tufts Health Public Plans | $82 - $513 | 1% |
| UnitedHealthcare | $82 - $710 | 1% |
| Vaya Health Lme | $82 - $513 | 1% |
| Washtenaw Health Plan | $82 - $513 | 1% |
| Wellsense Health Plan | $82 - $513 | 1% |
| Wi Womens Wellness | $82 - $513 | 1% |
| Webtpa | $87 - $544 | 1% |
| Molina Marketplace | $94 - $589 | 2% |
| Pacificsource Health Plans | $98 - $719 | 2% |
| First Choice Health | $99 - $617 | 2% |
| Moda Health | $99 - $620 | 2% |
| Mountain Health Co-Op | $99 - $620 | 2% |
| Providence | $99 - $617 | 2% |
| Selecthealth | $99 - $783 | 2% |
| Geha | $114 - $710 | 2% |
| Allied National Global Care | $124 - $777 | 2% |
| Asrm - Reliance Standard Life Insurance | $124 - $777 | 2% |
| Christian Care Ministry | $124 - $777 | 2% |
| Dean Health | $124 - $777 | 2% |
| Fallon Health | $124 - $777 | 2% |
| Family Life Insurance Company | $124 - $777 | 2% |
| Ghc Scw | $124 - $777 | 2% |
| International Benefit Administrators | $124 - $777 | 2% |
| Lifetime Benefit Solutions | $124 - $777 | 2% |
| Manhattan Life | $124 - $777 | 2% |
| Medi Share | $124 - $777 | 2% |
| Multiplan | $124 - $777 | 2% |
| Pai | $124 - $777 | 2% |
| Pan-American Life | $124 - $777 | 2% |
| Paramount Hmo | $124 - $777 | 2% |
| Phcs | $124 - $777 | 2% |
| Trinity Health Share | $124 - $777 | 2% |
| Andrie Inc | $171 - $857 | 3% |
| East Greenbush Central School District | $171 - $857 | 3% |
| Genex Wc | $171 - $857 | 3% |
| Healthsmart Workers Comp | $171 - $857 | 3% |
| Jag Source | $171 - $857 | 3% |
| New York State Insurance Fund | $171 - $857 | 3% |
| Njm Insurance Group | $171 - $857 | 3% |
| Rx Heatlhcomp | $171 - $857 | 3% |
| Rx Restat | $171 - $857 | 3% |
| Rx Saif Opdp Wc | $171 - $857 | 3% |
| Rx Worker'S Comp | $171 - $857 | 3% |
| Wc Accident Fund | $171 - $857 | 3% |
| Wc Ace | $171 - $857 | 3% |
| Wc Acs Federal Employees | $171 - $857 | 3% |
| Wc Acuity | $171 - $857 | 3% |
| Wc Advantage | $171 - $857 | 3% |
| Wc Aegis | $171 - $857 | 3% |
| Wc Aig | $171 - $857 | 3% |
| Wc Aims | $171 - $857 | 3% |
| Wc Alaska National Ins | $171 - $857 | 3% |
| Wc Align Network | $171 - $857 | 3% |
| Wc Allied | $171 - $857 | 3% |
| Wc Am Trust N America | $171 - $857 | 3% |
| Wc American Claims Mgmt | $171 - $857 | 3% |
| Wc Amerisure | $171 - $857 | 3% |
| Wc Amtrust | $171 - $857 | 3% |
| Wc Asu Risk Mgt | $171 - $857 | 3% |
| Wc Benetech | $171 - $857 | 3% |
| Wc Berkley Admin | $171 - $857 | 3% |
| Wc Broadspire | $171 - $857 | 3% |
| Wc Broward County | $171 - $857 | 3% |
| Wc Bunch & Associates | $171 - $857 | 3% |
| Wc California State Comp Ins | $171 - $857 | 3% |
| Wc California State Ins Fund | $171 - $857 | 3% |
| Wc Capitol Area Health Consortium | $171 - $857 | 3% |
| Wc Ccmsi | $171 - $857 | 3% |
| Wc Chartis | $171 - $857 | 3% |
| Wc Chubb | $171 - $857 | 3% |
| Wc Cirma | $171 - $857 | 3% |
| Wc City Of Albany | $171 - $857 | 3% |
| Wc City Of Sioux City | $171 - $857 | 3% |
| Wc Claims Mgmt Inc | $171 - $857 | 3% |
| Wc Cna | $171 - $857 | 3% |
| Wc Comp One Admin C/O Manageability | $171 - $857 | 3% |
| Wc Compone Admin | $171 - $857 | 3% |
| Wc Corvel | $171 - $857 | 3% |
| Wc Ct Healthcare Trust | $171 - $857 | 3% |
| Wc Donegal Insurance Group | $171 - $857 | 3% |
| Wc Emc Insurance Company | $171 - $857 | 3% |
| Wc Employee Mutual | $171 - $857 | 3% |
| Wc Enablecomp | $171 - $857 | 3% |
| Wc Encore Health Network | $171 - $857 | 3% |
| Wc Erie | $171 - $857 | 3% |
| Wc Esis | $171 - $857 | 3% |
| Wc Evolutions | $171 - $857 | 3% |
| Wc Fcci | $171 - $857 | 3% |
| Wc Fed Ex | $171 - $857 | 3% |
| Wc Federal Black Lung | $171 - $857 | 3% |
| Wc Federated | $171 - $857 | 3% |
| Wc Finley Occupational Health | $171 - $857 | 3% |
| Wc First Agency/Occunet | $171 - $857 | 3% |
| Wc Ford Motor | $171 - $857 | 3% |
| Wc Fresno Unified Emp | $171 - $857 | 3% |
| Wc Gallagher Bassett | $171 - $857 | 3% |
| Wc General Motors | $171 - $857 | 3% |
| Wc Generic | $171 - $857 | 3% |
| Wc Genex Care For Ohio | $171 - $857 | 3% |
| Wc Great West Casualty | $171 - $857 | 3% |
| Wc Guarantee Insurance | $171 - $857 | 3% |
| Wc Guard Insurance Company | $171 - $857 | 3% |
| Wc Hab | $171 - $857 | 3% |
| Wc Hartford | $171 - $857 | 3% |
| Wc Hastings | $171 - $857 | 3% |
| Wc Health Management | $171 - $857 | 3% |
| Wc Heritage Summit | $171 - $857 | 3% |
| Wc Hireright | $171 - $857 | 3% |
| Wc Horizon | $171 - $857 | 3% |
| Wc Icw Group | $171 - $857 | 3% |
| Wc Idaho State Ins Fund | $171 - $857 | 3% |
| Wc Intercare Insurance | $171 - $857 | 3% |
| Wc Intermountain | $171 - $857 | 3% |
| Wc Johns Eastern | $171 - $857 | 3% |
| Wc Kemberton | $171 - $857 | 3% |
| Wc Key Ins & Benefit Solutions | $171 - $857 | 3% |
| Wc Liberty Mutual | $171 - $857 | 3% |
| Wc Mac Risk Management | $171 - $857 | 3% |
| Wc Massachusetts | $171 - $857 | 3% |
| Wc Mdia | $171 - $857 | 3% |
| Wc Meadowbrook Claim | $171 - $857 | 3% |
| Wc Medical Administrators | $171 - $857 | 3% |
| Wc Meijers | $171 - $857 | 3% |
| Wc Memic | $171 - $857 | 3% |
| Wc Mercy Workcare | $171 - $857 | 3% |
| Wc Michigan | $171 - $857 | 3% |
| Wc Michigan Millers Mutual | $171 - $857 | 3% |
| Wc Mitchell Frankenmuth | $171 - $857 | 3% |
| Wc Mra | $171 - $857 | 3% |
| Wc Nationwide | $171 - $857 | 3% |
| Wc Nca Comp | $171 - $857 | 3% |
| Wc New York | $171 - $857 | 3% |
| Wc New York Special Funds | $171 - $857 | 3% |
| Wc North American Rishces | $171 - $857 | 3% |
| Wc Northeast Health | $171 - $857 | 3% |
| Wc Notre Dame | $171 - $857 | 3% |
| Wc Novanet | $171 - $857 | 3% |
| Wc O'Hara Corp | $171 - $857 | 3% |
| Wc Occ Health Allen | $171 - $857 | 3% |
| Wc Ohio Bureau | $171 - $857 | 3% |
| Wc One Call Medical | $171 - $857 | 3% |
| Wc Paradigm | $171 - $857 | 3% |
| Wc Peerless | $171 - $857 | 3% |
| Wc Pma | $171 - $857 | 3% |
| Wc Praxis Health Network | $171 - $857 | 3% |
| Wc Price Chopper | $171 - $857 | 3% |
| Wc Procura Management | $171 - $857 | 3% |
| Wc Qualcare | $171 - $857 | 3% |
| Wc Quiktrip | $171 - $857 | 3% |
| Wc Reny Company | $171 - $857 | 3% |
| Wc Rev Claims | $171 - $857 | 3% |
| Wc Risico | $171 - $857 | 3% |
| Wc Rural Mutual | $171 - $857 | 3% |
| Wc Saif Oregon | $171 - $857 | 3% |
| Wc Secura | $171 - $857 | 3% |
| Wc Sedgwick | $171 - $857 | 3% |
| Wc Sentry | $171 - $857 | 3% |
| Wc Sheakley Unicomp | $171 - $857 | 3% |
| Wc Smile Lodge | $171 - $857 | 3% |
| Wc Society | $171 - $857 | 3% |
| Wc Srs | $171 - $857 | 3% |
| Wc Taconic (Mro) | $171 - $857 | 3% |
| Wc Taconic Farms | $171 - $857 | 3% |
| Wc Travelers | $171 - $857 | 3% |
| Wc Triad Group | $171 - $857 | 3% |
| Wc Tristar | $171 - $857 | 3% |
| Wc Troy Ny | $171 - $857 | 3% |
| Wc Tyson | $171 - $857 | 3% |
| Wc Unified Health Services | $171 - $857 | 3% |
| Wc United Heartland | $171 - $857 | 3% |
| Wc Us Dept Of Labor | $171 - $857 | 3% |
| Wc Velocity | $171 - $857 | 3% |
| Wc Walmart | $171 - $857 | 3% |
| Wc West Bend | $171 - $857 | 3% |
| Wc West Bend Mutual/Argent | $171 - $857 | 3% |
| Wc Winnebago Industries | $171 - $857 | 3% |
| Wc Yankee Trails | $171 - $857 | 3% |
| Wc York Risk | $171 - $857 | 3% |
| Wc Zenith | $171 - $857 | 3% |
| Wc Zurich | $171 - $857 | 3% |
| Oregon Screenwise | $256 | 4% |
| Align Senior Care | $296 | 5% |
| Ally Align Care Adv | $296 | 5% |
| American Health Plan | $296 | 5% |
| Aurora Special Needs | $296 | 5% |
| Blue Care Network Advantage | $296 | 5% |
| Blue Shield - De (Highmark) Medciare Advantage | $296 | 5% |
| Care Dimensions | $296 | 5% |
| Care Improvement Plus | $296 | 5% |
| Care Resources Pace | $296 | 5% |
| Careplus Health Plans | $296 | 5% |
| Cca - Zing Health | $296 | 5% |
| Cca Senior Care Options | $296 | 5% |
| Central Valley Medical Services Corp Pace | $296 | 5% |
| Champion Health Plan Mcr Advantage | $296 | 5% |
| Clear Spring Health | $296 | 5% |
| Clover Health | $296 | 5% |
| Commonwealth Care Alliance | $296 | 5% |
| Community Pace At Home | $296 | 5% |
| Eddy Senior Care-Pace | $296 | 5% |
| Eddy Seniorcare Pace | $296 | 5% |
| Elementcare | $296 | 5% |
| Evercare | $296 | 5% |
| Everence | $296 | 5% |
| Gateway Health Plan | $296 | 5% |
| Genesys Pace Of Genesee County | $296 | 5% |
| Georgia Health Advantage | $296 | 5% |
| Gold Advantage | $296 | 5% |
| Gpa Croell Redi Mix | $296 | 5% |
| Health America Advantra | $296 | 5% |
| Highmark Health Options Dual Plan | $296 | 5% |
| Hope Select Pace | $296 | 5% |
| Horizon Nj Total Care | $296 | 5% |
| Hudson Headwaters Pace | $296 | 5% |
| Huron Valley Pace | $296 | 5% |
| Innovative Integrated Health Community Plans | $296 | 5% |
| Iowa Health Advantage | $296 | 5% |
| Johns Hopkins Advantage Md | $296 | 5% |
| Lasso Healthcare Msa | $296 | 5% |
| Life St Marys Pace | $296 | 5% |
| Lifecircles Pace | $296 | 5% |
| Longevity Health Plan | $296 | 5% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $296 | 5% |
| Martins Point Generations Advantage | $296 | 5% |
| Mass General Brigham Mcr Adv | $296 | 5% |
| Medicare (plans) | $296 - $332 | 5% |
| Medipak Advantage | $296 | 5% |
| Mercy Life | $296 | 5% |
| Mercyone Cedar Valley | $296 | 5% |
| Meridian Complete | $296 | 5% |
| Michigan Complete Health | $296 | 5% |
| Nascentia Health Plus | $296 | 5% |
| New Centry Health Careplus | $296 | 5% |
| Osu Prime Care Advantage | $296 | 5% |
| Pace Cny | $296 | 5% |
| Pace Iowa Immanuel Pathways | $296 | 5% |
| Pace Southeast | $296 | 5% |
| Pace-Trinity Health | $296 | 5% |
| Peak Pace Solutions | $296 | 5% |
| Perennial Advantage | $296 | 5% |
| Preferred Care Partners | $296 | 5% |
| Presbyterian Senior Plan | $296 | 5% |
| Provider Partners Health Plan Of Illinois | $296 | 5% |
| Provider Partners Health Plan Of Indiana | $296 | 5% |
| Pruitthealth Premier | $296 | 5% |
| Reliance Community Care Partners Care Resources Pace | $296 | 5% |
| Rx Allwin | $296 | 5% |
| Rx Grane Grnmedd | $296 | 5% |
| Rx Retiree Rx Care | $296 | 5% |
| Scan Health Plan Mcr Ipa Meritage Oon | $296 | 5% |
| Secure Horizons Ma Pffs | $296 | 5% |
| Serenity Pace | $296 | 5% |
| Siouxland Pace | $296 | 5% |
| Solis Health Plans | $296 | 5% |
| Sunnyview-Pace Finance Dept | $296 | 5% |
| Texan Plus | $296 | 5% |
| The Health Plan | $296 | 5% |
| Thome Pace | $296 | 5% |
| Todays Options | $296 | 5% |
| Tribute Health Plans | $296 | 5% |
| Um Health Advantage | $296 | 5% |
| Union Health Service | $296 | 5% |
| Welbe Health | $296 | 5% |
| Wellmed | $296 | 5% |
| Veterans Administration | $302 | 5% |
| American Health Advantage Of Idaho | $308 - $311 | 5% |
| Champva | $308 | 5% |
| Tricare | $308 | 5% |
| Triwest Health Alliance | $308 | 5% |
| Us Family Health Plan | $308 | 5% |
| Veterans Eval Services | $308 | 5% |