ER Visit Cost in Miami-Fort Lauderdale-West Palm Beach, FL
An emergency department visit is a hospital encounter in which staff assess a patient, run whatever tests or treatments are needed, and produce a visit record and, where ordered, imaging and lab results. The hospital facility fee covers the use of the emergency department itself, including the room, nursing, equipment and supplies, and it is billed separately from physician fees. This page covers three billing codes: 99283 (ER Visit Level 3, Moderate), 99284 (ER Visit Level 4, High/Urgent) and 99285 (ER Visit Level 5, Critical). All prices come from the price transparency files that CMS requires hospitals to publish, covering 30 hospitals in the Miami-Fort Lauderdale-West Palm Beach area.
Data last accessed by us: 2026-10-15 · Newest hospital file date among hospitals below: 2026-10-13
Data may be outdated
This hospital's pricing file has not been updated since 12/2/2025 (317 days ago). Prices may not reflect current charges. Contact the hospital directly for current pricing.
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If you are experiencing a medical emergency, call 911 or go to your nearest emergency room immediately.
Do not delay emergency care based on cost.
Incomplete rows: Some hospitals publish $0 / blank amounts for this procedure in their transparency file. Those cells show as N/A and are excluded from the cash range above.
ER Visit Level 3 (Moderate) (HCPCS 99283)
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* Hospitals marked with * publish cash prices equal to their gross charges, meaning no separate self-pay discount appears in their transparency file. The insured rates shown are negotiated rates between the hospital and specific insurance plans. Uninsured patients may be able to negotiate lower rates by contacting the hospital directly.
ER Visit Level 4 (High/Urgent) (HCPCS 99284)
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* Hospitals marked with * publish cash prices equal to their gross charges, meaning no separate self-pay discount appears in their transparency file. The insured rates shown are negotiated rates between the hospital and specific insurance plans. Uninsured patients may be able to negotiate lower rates by contacting the hospital directly.
ER Visit Level 5 (Critical) (HCPCS 99285)
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* Hospitals marked with * publish cash prices equal to their gross charges, meaning no separate self-pay discount appears in their transparency file. The insured rates shown are negotiated rates between the hospital and specific insurance plans. Uninsured patients may be able to negotiate lower rates by contacting the hospital directly.
What These Prices Mean
Reading gross, cash and insured figures
The gross charge is the hospital's list price, the cash price is what a self-pay patient is quoted, and the insured range spans the lowest to highest negotiated rates with health plans. At Baptist Hospital of Miami, the 99285 gross charge is $2,912, the cash price is $1,892.80 (65% of gross), and insured rates run from $173.17 to $2,912. At Jackson Memorial Hospital, cash for 99283 is $246 against a gross of $1,320, about 19%. People on a high-deductible plan who have not yet met the deductible usually pay the plan's negotiated rate rather than the gross charge.
How the three codes step up
The codes reflect increasing levels of emergency department resource use, from 99283 to 99285. At Jackson Memorial Hospital, gross charges are $1,320 for 99283, $2,317 for 99284 and $2,982 for 99285, with cash prices of $246, $387 and $555. At Holy Cross Hospital, cash prices are $148, $253 and $367 for the same codes, while gross charges there are not available. Level 5 generally carries the highest listed amounts at a given hospital, though HCA Florida Northwest Hospital lists $2,959 for 99284 and $2,906 for 99285.
The gross charge is the hospital's list price, the cash price is what a self-pay patient is quoted, and the insured range spans the lowest to highest negotiated rates with health plans. At Baptist Hospital of Miami, the 99285 gross charge is $2,912, the cash price is $1,892.80 (65% of gross), and insured rates run from $173.17 to $2,912. At Jackson Memorial Hospital, cash for 99283 is $246 against a gross of $1,320, about 19%. People on a high-deductible plan who have not yet met the deductible usually pay the plan's negotiated rate rather than the gross charge.
How the three codes step up
The codes reflect increasing levels of emergency department resource use, from 99283 to 99285. At Jackson Memorial Hospital, gross charges are $1,320 for 99283, $2,317 for 99284 and $2,982 for 99285, with cash prices of $246, $387 and $555. At Holy Cross Hospital, cash prices are $148, $253 and $367 for the same codes, while gross charges there are not available. Level 5 generally carries the highest listed amounts at a given hospital, though HCA Florida Northwest Hospital lists $2,959 for 99284 and $2,906 for 99285.
Why ER Visit Prices Vary
Discount policies differ by system
Across all hospitals, cash prices run from $148 at Holy Cross Hospital (99283) to $16,140 at HCA Florida Kendall Hospital (99285). Excluding hospitals whose cash equals gross, the range is $148 to $1,892.80 at Baptist Hospital of Miami (99285), and the highest is about 13x the lowest. Gross charges run from $508 at Lakeside Medical Center (99283) to $16,140, about 32x. Of 30 hospitals, 11 publish cash equal to gross, including all 10 HCA Healthcare hospitals and Mount Sinai Medical Center. Baptist Health South Florida lists cash at 65% of gross, Memorial Healthcare System at 70%, and Jackson Health System at 17% to 19%.
Other facilities and plan differences
Outpatient centers and other facilities outside this dataset may price differently. Plan-to-plan variation is also wide. At Holy Cross Hospital, the 3,144 published rates for 99285 range from $103.48 to $5,146, and the highest is about 50x the lowest. At HCA Florida Kendall Hospital, insured rates for 99285 reach $19,368.
Across all hospitals, cash prices run from $148 at Holy Cross Hospital (99283) to $16,140 at HCA Florida Kendall Hospital (99285). Excluding hospitals whose cash equals gross, the range is $148 to $1,892.80 at Baptist Hospital of Miami (99285), and the highest is about 13x the lowest. Gross charges run from $508 at Lakeside Medical Center (99283) to $16,140, about 32x. Of 30 hospitals, 11 publish cash equal to gross, including all 10 HCA Healthcare hospitals and Mount Sinai Medical Center. Baptist Health South Florida lists cash at 65% of gross, Memorial Healthcare System at 70%, and Jackson Health System at 17% to 19%.
Other facilities and plan differences
Outpatient centers and other facilities outside this dataset may price differently. Plan-to-plan variation is also wide. At Holy Cross Hospital, the 3,144 published rates for 99285 range from $103.48 to $5,146, and the highest is about 50x the lowest. At HCA Florida Kendall Hospital, insured rates for 99285 reach $19,368.
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Paying cash? Health insurance could lower your ER Visit cost.
Published cash prices on this page range from $148 to $16,140 (including hospitals that publish cash equal to gross charge, marked with * in the table). The lowest insured rate in the price table is $12.27 (Holy Cross Hospital). Insured rates depend on the plan, and the lowest are often Medicaid, CHIP or Medicare Advantage plans, so they may not reflect what a commercial or marketplace plan pays. If you are uninsured, a marketplace health plan could reduce your out-of-pocket cost for this procedure.
Links go to Healthcare.gov, the official federal health insurance marketplace. We are not affiliated with Healthcare.gov or any insurance provider. This is not a recommendation for any specific plan.
Compare Insurer Rates for ER Visit in Miami-Fort Lauderdale-West Palm Beach
How much does each insurance company pay for er visit at Miami-Fort Lauderdale-West Palm Beach hospitals?
| Insurer | Lowest Rate | Hospitals |
|---|---|---|
| Community Care Plan | $14.21 | 5 |
| Aetna | $14.71 | 29 |
| Superior Health Plan | $14.71 | 7 |
| Florida Blue | $14.71 | 25 |
| Cigna | $14.71 | 30 |
| Humana | $14.71 | 19 |
| Molina Healthcare | $14.71 | 19 |
| Simply Healthcare | $14.71 | 16 |
Rates shown are the lowest and highest negotiated rates each insurer has published across Miami-Fort Lauderdale-West Palm Beach hospitals for this procedure. Your actual cost depends on your plan's deductible, copay, and coinsurance.
What Insurers Actually Pay
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Published negotiated rates for ER Visit Level 5 (Critical) (HCPCS 99285) at Holy Cross Fort Lauderdale, outpatient facility fee:
ER Visit Level 5 (Critical) (99285), Holy Cross Fort Lauderdale Payer Rates
| Insurance Payer | Plan Type | Negotiated Rate |
|---|---|---|
| AVMED HEALTH PLAN | AVMED SELECT NETWORK | $103.48 |
| AVMED HEALTH PLAN | AVMED SELECT NETWORK | $103.48 |
| AVMED HEALTH PLAN | AVMED SELECT NETWORK | $103.48 |
| MEDICAID - MI | MEDICAID | $111.19 |
| MEDICAID - MI | MEDICAID | $111.19 |
| MEDICAID - IL | MEDICAID | $121.28 |
| MEDICAID - IL | MEDICAID | $121.28 |
| MOLINA MEDICAID | MOLINA HEALTHCARE MEDICAID | $124.18 |
| MOLINA MEDICAID | MOLINA HEALTHCARE MEDICAID | $124.18 |
| MOLINA MEDICAID | MOLINA HEALTHCARE MEDICAID | $124.18 |
| MEMORIAL INTEGRATED HEALTH | MEMORIAL INTEGRATED HEALTH | $128.85 |
| COMMUNITY CARE PLAN | MEMORIAL INTEGRATED HEALTH | $128.85 |
| CMH BERRIEN COUNTY | MEDICAID | $133.28 |
| CMH CASS COUNTY | MEDICAID | $133.28 |
| CMH CENTRAL MI COUNTY | MEDICAID | $133.28 |
| CMH ALLEGAN COUNTY | MEDICAID | $133.28 |
| CMH AUSABLE VALLEY | MEDICAID | $133.28 |
| BCCCP-MICHIGAN | MEDICAID | $133.28 |
| CMH OTTAWA COUNTY | MEDICAID | $133.28 |
| CMH VAN BUREN COUNTY | MEDICAID | $133.28 |
| CMH WASHTENAW COUNTY | MEDICAID | $133.28 |
| CMH DETROIT WAYNE INTEGRATED HEALTH NETWORK | MEDICAID | $133.28 |
| CMH WAYNE CTY/COM LIV SVCS | MEDICAID | $133.28 |
| CMH MONTCALM COUNTY | MEDICAID | $133.28 |
| CMH MUSKEGON COUNTY | MEDICAID | $133.28 |
| CMH NEWAYGO COUNTY | MEDICAID | $133.28 |
| CMH NORTHERN LAKES COUNTY | MEDICAID | $133.28 |
| CMH MONROE COUNTY | MEDICAID | $133.28 |
| CMH CLINTON-EATON-INGHAM COUNTY | MEDICAID | $133.28 |
| CMH GENESEE COUNTY | MEDICAID | $133.28 |
| CMH IONIA COUNTY | MEDICAID | $133.28 |
| CMH JACKSON COUNTY/LIFEWAYS | MEDICAID | $133.28 |
| BCCP | MEDICAID | $133.28 |
| MARYLAND HEALTHY SMILES - SCION DENTAL | MEDICAID | $133.28 |
| MEDICAID PENDING | MEDICAID | $133.28 |
| KEYSTONE FIRST | MEDICAID | $133.28 |
| BLUE CROSS - OH (ANTHEM) MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| COUNTY CARE MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| DELAWARE FIRST HEALTH | MEDICAID | $133.28 |
| AMISH MENNONITE | MEDICAID | $133.28 |
| MEDSTAR DC HEALTHY FAMILY | MEDICAID | $133.28 |
| MEDSTAR MD HEALTH CHOICE | MEDICAID | $133.28 |
| BLUE CROSS - ID MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| ID COUNTY CAT FUND | MEDICAID | $133.28 |
| ID COUNTY PAYETTE | MEDICAID | $133.28 |
| ID COUNTY ADA | MEDICAID | $133.28 |
| CENPATICO | MEDICAID | $133.28 |
| CHILDRENS COMM HEALTH PLAN | MEDICAID | $133.28 |
| MARYLAND BREAST & CERVICAL PROGRAM | MEDICAID | $133.28 |
| OREGON SCREENWISE | MEDICAID | $133.28 |
| SCREENING FOR LIFE | MEDICAID | $133.28 |
| CONNECTIONS CSP | MEDICAID | $133.28 |
| COMMUNITY CARE PARTNERS | MEDICAID | $133.28 |
| FRESNO COUNTY CCS | MEDICAID | $133.28 |
| HEALTH SAFETY NET | MEDICAID | $133.28 |
| IDAHO WOMENS HEALTH CHECK | MEDICAID | $133.28 |
| INDIANA BREAST CERVICAL CANCER | MEDICAID | $133.28 |
| NEW YORK CANCER SERVICES PROGRAM | MEDICAID | $133.28 |
| CMH WAYNE COUNTY/CARELINK | MEDICAID | $133.28 |
| RX MEDI-CAL | MEDICAID | $133.28 |
| MEDICAID - NY SSL | MEDICAID | $133.28 |
| DPH TB PROGRAM | MEDICAID | $133.28 |
| MEDICAID - WY | MEDICAID | $133.28 |
| MEDICAID OOS NHI | MEDICAID | $133.28 |
| BREAST GRANT-CONNECTICUT | MEDICAID | $133.28 |
| PACE OF SOUTHWEST MICHIGAN | MEDICAID | $133.28 |
| MEDICAID - VA | MEDICAID | $133.28 |
| MEDICAID - WA | MEDICAID | $133.28 |
| MEDICAID - WV | MEDICAID | $133.28 |
| MEDICAID - WI | MEDICAID | $133.28 |
| MEDICAID - SD | MEDICAID | $133.28 |
| MEDICAID - TN | MEDICAID | $133.28 |
| MEDICAID - TX | MEDICAID | $133.28 |
| WI WOMENS WELLNESS | MEDICAID | $133.28 |
| MANAGED HEALTH SERVICES - INDIANA | MEDICAID | $133.28 |
| NEBRASKA TOTAL CARE | MEDICAID | $133.28 |
| MERCYCARE MEDICAID | MEDICAID | $133.28 |
| DEAN WI BADGERCARE | MEDICAID | $133.28 |
| GHC SCW WI BADGERCARE | MEDICAID | $133.28 |
| CARE WISCONSIN MEDICAID | MEDICAID | $133.28 |
| WELLPOINT MEDICAID | MEDICAID | $133.28 |
| BUCKEYE HEALTH PLAN MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| CIGNA MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| HUMANA MEDICAID | HUMANA MEDICAID | $133.28 |
| UPPER PENINSULA HEALTH PLAN (UPHP) MEDICAID | MEDICAID | $133.28 |
| JEFFERSON HEALTH PLANS MEDICAID | MEDICAID | $133.28 |
| POSITIVE HEALTHCARE PARTNERS MEDICAID | MEDICAID | $133.28 |
| MEDICAID - UT | MEDICAID | $133.28 |
| MEDICAID - VT | MEDICAID | $133.28 |
| MEDICAID - OK | MEDICAID | $133.28 |
| CHILDRENS MEDICAL SERVICES TITLE 19 | MEDICAID | $133.28 |
| SIMPLY HEALTHCARE MEDICAID | MEDICAID | $133.28 |
| TRILOGY MEDICAID | MEDICAID | $133.28 |
| COUNTY CARE MEDICAID | MEDICAID | $133.28 |
| NEXTLEVEL HEALTH | MEDICAID | $133.28 |
| HEALTHY BLUE NE | MEDICAID | $133.28 |
| FAMILY HEALTH NETWORK | MEDICAID | $133.28 |
| GEISINGER MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| MERIDIAN MEDICAID | MEDICAID | $133.28 |
| BLUE PLUS MO MEDICAID | MEDICAID | $133.28 |
| HEALTHY BLUE PLUS MO MEDICAID | MEDICAID | $133.28 |
| PRIORITY PARTNERS | MEDICAID | $133.28 |
| MO HOME STATE HEALTH PLAN | MEDICAID | $133.28 |
| IOWA TOTAL CARE | MEDICAID | $133.28 |
| RX MEDICAID | MEDICAID | $133.28 |
| AETNA MEDICAID | MEDICAID | $133.28 |
| ICARE MEDICAID | MEDICAID | $133.28 |
| LAKELAND CARE INC | MEDICAID | $133.28 |
| HENNEPIN HEALTH | MEDICAID | $133.28 |
| UNITED HEALTHCARE MEDICAID | MEDICAID | $133.28 |
| PRESBYTERIAN CENTENNIAL CARE | MEDICAID | $133.28 |
| HEALTHFIRST MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| VAYA HEALTH LME | MEDICAID | $133.28 |
| SANDHILLS CENTER LME | MEDICAID | $133.28 |
| COMMUNITY HEALTH CHOICE | MEDICAID | $133.28 |
| TUFTS HEALTH PUBLIC PLANS | MEDICAID | $133.28 |
| BLUE CROSS - SC MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| EASTPOINTE LME | MEDICAID | $133.28 |
| CARDINAL INNOVATIONS LME | MEDICAID | $133.28 |
| PARTNERS BEHAVIORAL LME | MEDICAID | $133.28 |
| TENNCARE | MEDICAID | $133.28 |
| BLUE CROSS - NM MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| CMH WEST MI COUNTY | MEDICAID | $133.28 |
| PARAMOUNT ADVANTAGE | MEDICAID | $133.28 |
| COUNTY CORONER | MEDICAID | $133.28 |
| ST JOSEPH COUNTY HLTH DPT | MEDICAID | $133.28 |
| ID COUNTY CANYON | MEDICAID | $133.28 |
| ALLWELL MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| BLUE CROSS - IN (ANTHEM) MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| COMMUNITY CARE MEDICAID | MEDICAID | $133.28 |
| DEAN HEALTH MEDICAID | MEDICAID | $133.28 |
| GROUP HEALTH COOPERATIVE MEDICAID | MEDICAID | $133.28 |
| MEDICAID MA QMB | MEDICAID | $133.28 |
| KEYSTONE FIRST CHIP | MEDICAID | $133.28 |
| BLUE CROSS - IL MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| ILLINICARE HEALTH MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| ALLWELL PA HEALTH & WELLNESS MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| BLUE CROSS - NY (ANTHEM) MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| COMMUNITY BENEFIT HEALTH | MEDICAID | $133.28 |
| AFFINITY HEALTH PLAN MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| PRESTIGE HEALTH CHOICE | MEDICAID | $133.28 |
| MOLINA CENTENNIAL CARE | MEDICAID | $133.28 |
| UNITY MEDICAID | MEDICAID | $133.28 |
| AMERIHEALTH CARITAS MEDICAID | MEDICAID | $133.28 |
| SECURITY HEALTH MEDICAID | MEDICAID | $133.28 |
| CARESOURCE MEDICAID | MEDICAID | $133.28 |
| BLUE CROSS - TN MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| PARAMOUNT MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| TOTAL HEALTH CARE MEDICAID | MEDICAID | $133.28 |
| CHHUNY | MEDICAID | $133.28 |
| BLUE CROSS - NY (EXCELLUS) MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| CARELON HEALTH MEDICAID | MEDICAID | $133.28 |
| MEDICAID ADVANTAGE GENERIC | MEDICAID | $133.28 |
| CAPITAL DISTRICT PHYSICIANS HEALTH MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| DELTA DENTAL NJ | MEDICAID | $133.28 |
| JAI MEDICAL SYSTEM | MEDICAID | $133.28 |
| MARYLAND PHYSICIANS CARE | MEDICAID | $133.28 |
| KEYSTONE FIRST CHC MEDICAID | MEDICAID | $133.28 |
| INDEPENDENT CARE MEDICAID | MEDICAID | $133.28 |
| PARKLAND COMMUNITY HEALTH PLAN | MEDICAID | $133.28 |
| PEACH STATE HEALTHPLAN | MEDICAID | $133.28 |
| MEDI-CAL HEALTHNET | MEDICAID | $133.28 |
| COMMUNITY CARE BEHAVORIAL HEALTH | MEDICAID | $133.28 |
| CALIFORNIA HEALTH AND WELLNESS | MEDICAID | $133.28 |
| WELLSENSE HEALTH PLAN | MEDICAID | $133.28 |
| CMH OAKLAND COUNTY | MEDICAID | $133.28 |
| NASCENTIA HEALTH OPTIONS | MEDICAID | $133.28 |
| INTERCOMMUNITY HEALTH OHP | MEDICAID | $133.28 |
| FREEDOM FIRST HEALTHCARE | MEDICAID | $133.28 |
| BLUE CROSS - DE (HIGHMARK) MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| SUPERIOR HEALTH | MEDICAID | $133.28 |
| CHILDRENS MEDICAL CENTER HEALTH PLAN MANAGED MEDICAID | MEDICAID | $133.28 |
| PHILADELPHIA COUNTY FUNDING | MEDICAID | $133.28 |
| HURON VALLEY PACE MEDICAID | MEDICAID | $133.28 |
| FIDELIS CARE MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| ROBERT F SING PROGRAM | MEDICAID | $133.28 |
| ALBANY COUNTY CORRECTIONAL FACILITY | MEDICAID | $133.28 |
| MEDICAID - AL | MEDICAID | $133.28 |
| MEDICAID - AK | MEDICAID | $133.28 |
| MEDICAID - AZ | MEDICAID | $133.28 |
| MEDICAID - AR | MEDICAID | $133.28 |
| BLUE CROSS - MD (CAREFIRST) MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| BLUE CROSS - DC (CAREFIRST) MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| KAISER PERMANENTE MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| UPMC MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| HEALTH PLUS PHSP MEDICAID ADV | MEDICAID | $133.28 |
| CENTENE | MEDICAID | $133.28 |
| CARE CONNECTIONS OF NORTHERN IOWA | MEDICAID | $133.28 |
| EMBLEM HEALTH MEDICAID | MEDICAID | $133.28 |
| TEXAS CHILDREN'S HEALTH PLAN | MEDICAID | $133.28 |
| FIRSTCARE MEDICAID | MEDICAID | $133.28 |
| MEDICAID - KY | MEDICAID | $133.28 |
| MEDICAID - LA | MEDICAID | $133.28 |
| METROPLUS MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| BLUE CROSS - NJ (HORIZON) MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| GREEN MOUNTAIN MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| PACIFICSOURCE HEALTH PLANS MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| TRILLIUM COMMUNITY OHP | MEDICAID | $133.28 |
| DSCC | MEDICAID | $133.28 |
| HIGHMARK WHOLECARE MEDICAID | MEDICAID | $133.28 |
| HEALTH NEW ENGLAND MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| MASSACHUSETTS BEHAVIORAL HEALTH PARTNERSHIP | MEDICAID | $133.28 |
| COMMONWEALTH CARE ALLIANCE MEDICAID | MEDICAID | $133.28 |
| MAGELLAN BEHAVIORAL HEALTH MEDICAID | MEDICAID | $133.28 |
| MEDI-CAL BLUE CROSS | MEDICAID | $133.28 |
| MEDI-CAL | MEDICAID | $133.28 |
| PRIORITY HEALTH MEDICAID | MEDICAID | $133.28 |
| MVP MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| VNSNY CHOICE MEDICAID | MEDICAID | $133.28 |
| MDWISE | MEDICAID | $133.28 |
| HAP MEDICAID | MEDICAID | $133.28 |
| HARBOR HEALTH | MEDICAID | $133.28 |
| WASHTENAW HEALTH PLAN | MEDICAID | $133.28 |
| UCARE MEDICAID | MEDICAID | $133.28 |
| CARE OREGON OHP | MEDICAID | $133.28 |
| SOUTH COUNTRY HEALTH ALLIANCE MEDICAID | MEDICAID | $133.28 |
| COMMUNITY CARE PLAN MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| RX MERIDIAN RX | MEDICAID | $133.28 |
| RX 340B PASS ALONG | MEDICAID | $133.28 |
| RX ASSISTANCE/RX MANUFACTURER ASSISTANCE 0 COPAY | MEDICAID | $133.28 |
| MEDICAID - IN | MEDICAID | $133.28 |
| MEDICAID - IA | MEDICAID | $133.28 |
| MEDICAID - KS | MEDICAID | $133.28 |
| MEDICAID - PA | MEDICAID | $133.28 |
| BLUE CROSS COMPLETE - MI | MEDICAID | $133.28 |
| RYAN WHITE FLORIDA MSSRP | MEDICAID | $133.28 |
| DELAWARE COUNTY DEPARTMENT OF HEALTH | MEDICAID | $133.28 |
| STEPHENSON CTY HEALTH | MEDICAID | $133.28 |
| CMH MACOMB | MEDICAID | $133.28 |
| CMH KALAMAZOO | MEDICAID | $133.28 |
| ASCENSION ST. VINCENT PUBLIC SAFETY MEDICAL | MEDICAID | $133.28 |
| IDAHO DEPT HEALTH AND WELLFARE | MEDICAID | $133.28 |
| MCLAREN HEALTH MEDICAID | MEDICAID | $133.28 |
| AMERIGROUP MEDICAID | MEDICAID | $133.28 |
| BMC HEALTHNET | MEDICAID | $133.28 |
| CMH LENAWEE COUNTY | MEDICAID | $133.28 |
| CMH LIVINGSTON COUNTY | MEDICAID | $133.28 |
| CMH MISC | MEDICAID | $133.28 |
| FALLON HEALTH MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| MEDICAID - FL | MEDICAID | $133.28 |
| MEDICAID - GA | MEDICAID | $133.28 |
| MEDICAID - HI | MEDICAID | $133.28 |
| MEDICAID - CO | MEDICAID | $133.28 |
| MEDICAID - CT | MEDICAID | $133.28 |
| MEDICAID - DE | MEDICAID | $133.28 |
| MEDICAID - DC | MEDICAID | $133.28 |
| MEDICAID - RI | MEDICAID | $133.28 |
| MEDICAID - SC | MEDICAID | $133.28 |
| MEDICAID - NY | MEDICAID | $133.28 |
| MEDICAID - NC | MEDICAID | $133.28 |
| MEDICAID - ND | MEDICAID | $133.28 |
| MEDICAID - OH | MEDICAID | $133.28 |
| MEDICAID - NV | MEDICAID | $133.28 |
| MEDICAID - NH | MEDICAID | $133.28 |
| MEDICAID - NJ | MEDICAID | $133.28 |
| MEDICAID - NM | MEDICAID | $133.28 |
| MEDICAID - MN | MEDICAID | $133.28 |
| MEDICAID - MS | MEDICAID | $133.28 |
| MEDICAID - MO | MEDICAID | $133.28 |
| COVID19 HRSA UNINSURED TESTING AND TREATMENT FUND | MEDICAID | $133.28 |
| CMH KENT COUNTY | MEDICAID | $133.28 |
| CMH BARRY COUNTY | MEDICAID | $133.28 |
| CMH BAY-ARENAC COUNTY | MEDICAID | $133.28 |
| KERN FAMILY HEALTH PLAN | MEDICAID | $133.28 |
| LA CARE HEALTH PLAN | MEDICAID | $133.28 |
| CITY OF PHILADELPHIA | MEDICAID | $133.28 |
| COUNTY FUNDING GENERIC | MEDICAID | $133.28 |
| CENCAL HEALTH PLAN | MEDICAID | $133.28 |
| MEDICAID - MA | MEDICAID | $133.28 |
| MEDICAID - MT | MEDICAID | $133.28 |
| MEDICAID - ME | MEDICAID | $133.28 |
| MEDICAID - MD | MEDICAID | $133.28 |
| MODA PLUS MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| INLAND EMPIRE HEALTH PLAN | MEDICAID | $133.28 |
| MEDICAID SPENDDOWN | MEDICAID | $133.28 |
| BROWARD COUNTY DEPT OF HEALTH | MEDICAID | $133.28 |
| CMH NORTH COUNTRY | MEDICAID | $133.28 |
| ID COUNTY OTHER | MEDICAID | $133.28 |
| CMH NEWAYGO COUNTY | MEDICAID | $133.28 |
| CMH NORTHERN LAKES COUNTY | MEDICAID | $133.28 |
| CMH OAKLAND COUNTY | MEDICAID | $133.28 |
| CMH MONROE COUNTY | MEDICAID | $133.28 |
| CMH MONTCALM COUNTY | MEDICAID | $133.28 |
| CMH MUSKEGON COUNTY | MEDICAID | $133.28 |
| CMH LIVINGSTON COUNTY | MEDICAID | $133.28 |
| CARE WISCONSIN MEDICAID | MEDICAID | $133.28 |
| CIGNA MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| HUMANA MEDICAID | HUMANA MEDICAID | $133.28 |
| UPPER PENINSULA HEALTH PLAN (UPHP) MEDICAID | MEDICAID | $133.28 |
| SANDHILLS CENTER LME | MEDICAID | $133.28 |
| BLUE CROSS - SC MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| EASTPOINTE LME | MEDICAID | $133.28 |
| PRESTIGE HEALTH CHOICE | MEDICAID | $133.28 |
| MOLINA CENTENNIAL CARE | MEDICAID | $133.28 |
| BLUE CROSS - TN MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| TENNCARE | MEDICAID | $133.28 |
| JAI MEDICAL SYSTEM | MEDICAID | $133.28 |
| INDEPENDENT CARE MEDICAID | MEDICAID | $133.28 |
| PARKLAND COMMUNITY HEALTH PLAN | MEDICAID | $133.28 |
| GREEN MOUNTAIN MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| PACIFICSOURCE HEALTH PLANS MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| TRILLIUM COMMUNITY OHP | MEDICAID | $133.28 |
| ILLINICARE HEALTH MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| METROPLUS MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| BLUE CROSS - NJ (HORIZON) MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| HEALTH NEW ENGLAND MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| MASSACHUSETTS BEHAVIORAL HEALTH PARTNERSHIP | MEDICAID | $133.28 |
| AFFINITY HEALTH PLAN MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| MARYLAND HEALTHY SMILES - SCION DENTAL | MEDICAID | $133.28 |
| BCCP | MEDICAID | $133.28 |
| JEFFERSON HEALTH PLANS MEDICAID | MEDICAID | $133.28 |
| CMH WAYNE COUNTY/CARELINK | MEDICAID | $133.28 |
| RX MEDI-CAL | MEDICAID | $133.28 |
| BLUE CROSS - NM MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| SECURITY HEALTH MEDICAID | MEDICAID | $133.28 |
| CARESOURCE MEDICAID | MEDICAID | $133.28 |
| MERCYCARE MEDICAID | MEDICAID | $133.28 |
| UNITY MEDICAID | MEDICAID | $133.28 |
| FIDELIS CARE MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| EMBLEM HEALTH MEDICAID | MEDICAID | $133.28 |
| PRESBYTERIAN CENTENNIAL CARE | MEDICAID | $133.28 |
| HEALTHFIRST MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| TEXAS CHILDREN'S HEALTH PLAN | MEDICAID | $133.28 |
| FIRSTCARE MEDICAID | MEDICAID | $133.28 |
| PRIORITY PARTNERS | MEDICAID | $133.28 |
| DSCC | MEDICAID | $133.28 |
| HIGHMARK WHOLECARE MEDICAID | MEDICAID | $133.28 |
| BLUE CROSS - NY (ANTHEM) MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| COMMUNITY BENEFIT HEALTH | MEDICAID | $133.28 |
| MEDICAID - AZ | MEDICAID | $133.28 |
| MEDICAID - AR | MEDICAID | $133.28 |
| MEDICAID - AL | MEDICAID | $133.28 |
| MEDICAID - AK | MEDICAID | $133.28 |
| KAISER PERMANENTE MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| CARE CONNECTIONS OF NORTHERN IOWA | MEDICAID | $133.28 |
| BLUE CROSS - MD (CAREFIRST) MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| MEDICAID PENDING | MEDICAID | $133.28 |
| UCARE MEDICAID | MEDICAID | $133.28 |
| COMMUNITY HEALTH CHOICE | MEDICAID | $133.28 |
| TUFTS HEALTH PUBLIC PLANS | MEDICAID | $133.28 |
| CARDINAL INNOVATIONS LME | MEDICAID | $133.28 |
| PARTNERS BEHAVIORAL LME | MEDICAID | $133.28 |
| VAYA HEALTH LME | MEDICAID | $133.28 |
| PHILADELPHIA COUNTY FUNDING | MEDICAID | $133.28 |
| HURON VALLEY PACE MEDICAID | MEDICAID | $133.28 |
| BLUE CROSS - DC (CAREFIRST) MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| UPMC MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| HEALTH PLUS PHSP MEDICAID ADV | MEDICAID | $133.28 |
| CENTENE | MEDICAID | $133.28 |
| MEDICAID - KS | MEDICAID | $133.28 |
| FALLON HEALTH MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| MEDICAID - IN | MEDICAID | $133.28 |
| MEDICAID - GA | MEDICAID | $133.28 |
| MEDICAID - HI | MEDICAID | $133.28 |
| MEDICAID - DC | MEDICAID | $133.28 |
| MEDICAID - FL | MEDICAID | $133.28 |
| CARE OREGON OHP | MEDICAID | $133.28 |
| SOUTH COUNTRY HEALTH ALLIANCE MEDICAID | MEDICAID | $133.28 |
| MEDICAID - CO | MEDICAID | $133.28 |
| MEDICAID - CT | MEDICAID | $133.28 |
| MEDICAID - DE | MEDICAID | $133.28 |
| RX 340B PASS ALONG | MEDICAID | $133.28 |
| RX ASSISTANCE/RX MANUFACTURER ASSISTANCE 0 COPAY | MEDICAID | $133.28 |
| MAGELLAN BEHAVIORAL HEALTH MEDICAID | MEDICAID | $133.28 |
| CMH WEST MI COUNTY | MEDICAID | $133.28 |
| PARAMOUNT ADVANTAGE | MEDICAID | $133.28 |
| COMMUNITY CARE PLAN MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| RX MERIDIAN RX | MEDICAID | $133.28 |
| MEDICAID - IA | MEDICAID | $133.28 |
| GEISINGER MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| MERIDIAN MEDICAID | MEDICAID | $133.28 |
| NEXTLEVEL HEALTH | MEDICAID | $133.28 |
| AMERIGROUP MEDICAID | MEDICAID | $133.28 |
| COVID19 HRSA UNINSURED TESTING AND TREATMENT FUND | MEDICAID | $133.28 |
| ALBANY COUNTY CORRECTIONAL FACILITY | MEDICAID | $133.28 |
| MEDICAID - MO | MEDICAID | $133.28 |
| MEDICAID - MD | MEDICAID | $133.28 |
| MEDICAID - MA | MEDICAID | $133.28 |
| MEDICAID - LA | MEDICAID | $133.28 |
| MEDICAID - ME | MEDICAID | $133.28 |
| MEDICAID - KY | MEDICAID | $133.28 |
| COUNTY CORONER | MEDICAID | $133.28 |
| ST JOSEPH COUNTY HLTH DPT | MEDICAID | $133.28 |
| FAMILY HEALTH NETWORK | MEDICAID | $133.28 |
| INTERCOMMUNITY HEALTH OHP | MEDICAID | $133.28 |
| HAP MEDICAID | MEDICAID | $133.28 |
| WASHTENAW HEALTH PLAN | MEDICAID | $133.28 |
| ROBERT F SING PROGRAM | MEDICAID | $133.28 |
| DELAWARE COUNTY DEPARTMENT OF HEALTH | MEDICAID | $133.28 |
| STEPHENSON CTY HEALTH | MEDICAID | $133.28 |
| IDAHO DEPT HEALTH AND WELLFARE | MEDICAID | $133.28 |
| MEDICAID - ND | MEDICAID | $133.28 |
| MEDICAID - OH | MEDICAID | $133.28 |
| MEDICAID - NM | MEDICAID | $133.28 |
| MEDICAID - NY | MEDICAID | $133.28 |
| MEDICAID - NC | MEDICAID | $133.28 |
| MEDICAID - NV | MEDICAID | $133.28 |
| MEDICAID - NH | MEDICAID | $133.28 |
| MEDICAID - NJ | MEDICAID | $133.28 |
| POSITIVE HEALTHCARE PARTNERS MEDICAID | MEDICAID | $133.28 |
| CALIFORNIA HEALTH AND WELLNESS | MEDICAID | $133.28 |
| MCLAREN HEALTH MEDICAID | MEDICAID | $133.28 |
| MDWISE | MEDICAID | $133.28 |
| HARBOR HEALTH | MEDICAID | $133.28 |
| BMC HEALTHNET | MEDICAID | $133.28 |
| CMH ALLEGAN COUNTY | MEDICAID | $133.28 |
| CMH AUSABLE VALLEY | MEDICAID | $133.28 |
| CMH BARRY COUNTY | MEDICAID | $133.28 |
| RYAN WHITE FLORIDA MSSRP | MEDICAID | $133.28 |
| CMH MACOMB | MEDICAID | $133.28 |
| CMH KALAMAZOO | MEDICAID | $133.28 |
| ASCENSION ST. VINCENT PUBLIC SAFETY MEDICAL | MEDICAID | $133.28 |
| HEALTH SAFETY NET | MEDICAID | $133.28 |
| IDAHO WOMENS HEALTH CHECK | MEDICAID | $133.28 |
| INDIANA BREAST CERVICAL CANCER | MEDICAID | $133.28 |
| MEDI-CAL BLUE CROSS | MEDICAID | $133.28 |
| MEDI-CAL | MEDICAID | $133.28 |
| FRESNO COUNTY CCS | MEDICAID | $133.28 |
| VNSNY CHOICE MEDICAID | MEDICAID | $133.28 |
| MEDICAID - MT | MEDICAID | $133.28 |
| MEDICAID - MN | MEDICAID | $133.28 |
| MEDICAID - MS | MEDICAID | $133.28 |
| MEDICAID - WA | MEDICAID | $133.28 |
| MEDICAID - WV | MEDICAID | $133.28 |
| MEDICAID - UT | MEDICAID | $133.28 |
| MEDICAID - VT | MEDICAID | $133.28 |
| MEDICAID - VA | MEDICAID | $133.28 |
| MEDICAID - TN | MEDICAID | $133.28 |
| MEDICAID - TX | MEDICAID | $133.28 |
| MEDICAID - PA | MEDICAID | $133.28 |
| MEDICAID - RI | MEDICAID | $133.28 |
| COMMONWEALTH CARE ALLIANCE MEDICAID | MEDICAID | $133.28 |
| COMMUNITY CARE BEHAVORIAL HEALTH | MEDICAID | $133.28 |
| BCCCP-MICHIGAN | MEDICAID | $133.28 |
| CMH MISC | MEDICAID | $133.28 |
| CMH JACKSON COUNTY/LIFEWAYS | MEDICAID | $133.28 |
| CMH KENT COUNTY | MEDICAID | $133.28 |
| CMH LENAWEE COUNTY | MEDICAID | $133.28 |
| CMH GENESEE COUNTY | MEDICAID | $133.28 |
| PRIORITY HEALTH MEDICAID | MEDICAID | $133.28 |
| MVP MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| BLUE CROSS COMPLETE - MI | MEDICAID | $133.28 |
| COMMUNITY CARE PARTNERS | MEDICAID | $133.28 |
| MEDICAID - SC | MEDICAID | $133.28 |
| MEDICAID - SD | MEDICAID | $133.28 |
| MEDICAID - OK | MEDICAID | $133.28 |
| BLUE CROSS - IL MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| CENPATICO | MEDICAID | $133.28 |
| MEDICAID - NY SSL | MEDICAID | $133.28 |
| DPH TB PROGRAM | MEDICAID | $133.28 |
| MEDICAID MA QMB | MEDICAID | $133.28 |
| MARYLAND BREAST & CERVICAL PROGRAM | MEDICAID | $133.28 |
| OREGON SCREENWISE | MEDICAID | $133.28 |
| SCREENING FOR LIFE | MEDICAID | $133.28 |
| BREAST GRANT-CONNECTICUT | MEDICAID | $133.28 |
| TOTAL HEALTH CARE MEDICAID | MEDICAID | $133.28 |
| BLUE CROSS - OH (ANTHEM) MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| CMH IONIA COUNTY | MEDICAID | $133.28 |
| CMH CASS COUNTY | MEDICAID | $133.28 |
| CMH CENTRAL MI COUNTY | MEDICAID | $133.28 |
| CMH CLINTON-EATON-INGHAM COUNTY | MEDICAID | $133.28 |
| CMH BAY-ARENAC COUNTY | MEDICAID | $133.28 |
| CMH BERRIEN COUNTY | MEDICAID | $133.28 |
| CMH DETROIT WAYNE INTEGRATED HEALTH NETWORK | MEDICAID | $133.28 |
| CMH WAYNE CTY/COM LIV SVCS | MEDICAID | $133.28 |
| CMH OTTAWA COUNTY | MEDICAID | $133.28 |
| CMH VAN BUREN COUNTY | MEDICAID | $133.28 |
| CMH WASHTENAW COUNTY | MEDICAID | $133.28 |
| CONNECTIONS CSP | MEDICAID | $133.28 |
| NEW YORK CANCER SERVICES PROGRAM | MEDICAID | $133.28 |
| PACE OF SOUTHWEST MICHIGAN | MEDICAID | $133.28 |
| MEDICAID - WI | MEDICAID | $133.28 |
| MEDICAID - WY | MEDICAID | $133.28 |
| MEDICAID OOS NHI | MEDICAID | $133.28 |
| AETNA MEDICAID | MEDICAID | $133.28 |
| HENNEPIN HEALTH | MEDICAID | $133.28 |
| UNITED HEALTHCARE MEDICAID | MEDICAID | $133.28 |
| ALLWELL MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| ICARE MEDICAID | MEDICAID | $133.28 |
| LAKELAND CARE INC | MEDICAID | $133.28 |
| COMMUNITY CARE MEDICAID | MEDICAID | $133.28 |
| DEAN HEALTH MEDICAID | MEDICAID | $133.28 |
| AMISH MENNONITE | MEDICAID | $133.28 |
| MODA PLUS MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| DELAWARE FIRST HEALTH | MEDICAID | $133.28 |
| KEYSTONE FIRST | MEDICAID | $133.28 |
| BLUE CROSS - ID MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| MEDSTAR MD HEALTH CHOICE | MEDICAID | $133.28 |
| MEDSTAR DC HEALTHY FAMILY | MEDICAID | $133.28 |
| COUNTY CARE MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| AMERIHEALTH CARITAS MEDICAID | MEDICAID | $133.28 |
| MANAGED HEALTH SERVICES - INDIANA | MEDICAID | $133.28 |
| NEBRASKA TOTAL CARE | MEDICAID | $133.28 |
| WELLPOINT MEDICAID | MEDICAID | $133.28 |
| BUCKEYE HEALTH PLAN MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| WI WOMENS WELLNESS | MEDICAID | $133.28 |
| DEAN WI BADGERCARE | MEDICAID | $133.28 |
| GHC SCW WI BADGERCARE | MEDICAID | $133.28 |
| GROUP HEALTH COOPERATIVE MEDICAID | MEDICAID | $133.28 |
| CHILDRENS COMM HEALTH PLAN | MEDICAID | $133.28 |
| BLUE CROSS - IN (ANTHEM) MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| KEYSTONE FIRST CHIP | MEDICAID | $133.28 |
| WELLSENSE HEALTH PLAN | MEDICAID | $133.28 |
| CHILDRENS MEDICAL SERVICES TITLE 19 | MEDICAID | $133.28 |
| BLUE CROSS - DE (HIGHMARK) MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| SUPERIOR HEALTH | MEDICAID | $133.28 |
| CHILDRENS MEDICAL CENTER HEALTH PLAN MANAGED MEDICAID | MEDICAID | $133.28 |
| SIMPLY HEALTHCARE MEDICAID | MEDICAID | $133.28 |
| PARAMOUNT MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| ID COUNTY OTHER | MEDICAID | $133.28 |
| ID COUNTY PAYETTE | MEDICAID | $133.28 |
| ID COUNTY CAT FUND | MEDICAID | $133.28 |
| ID COUNTY ADA | MEDICAID | $133.28 |
| ID COUNTY CANYON | MEDICAID | $133.28 |
| HEALTHY BLUE PLUS MO MEDICAID | MEDICAID | $133.28 |
| MO HOME STATE HEALTH PLAN | MEDICAID | $133.28 |
| HEALTHY BLUE NE | MEDICAID | $133.28 |
| BLUE PLUS MO MEDICAID | MEDICAID | $133.28 |
| TRILOGY MEDICAID | MEDICAID | $133.28 |
| COUNTY CARE MEDICAID | MEDICAID | $133.28 |
| MEDICAID ADVANTAGE GENERIC | MEDICAID | $133.28 |
| CAPITAL DISTRICT PHYSICIANS HEALTH MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| ALLWELL PA HEALTH & WELLNESS MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| BLUE CROSS - NY (EXCELLUS) MEDICAID ADVANTAGE | MEDICAID | $133.28 |
| CARELON HEALTH MEDICAID | MEDICAID | $133.28 |
| MARYLAND PHYSICIANS CARE | MEDICAID | $133.28 |
| KEYSTONE FIRST CHC MEDICAID | MEDICAID | $133.28 |
| CHHUNY | MEDICAID | $133.28 |
| FREEDOM FIRST HEALTHCARE | MEDICAID | $133.28 |
| DELTA DENTAL NJ | MEDICAID | $133.28 |
| LA CARE HEALTH PLAN | MEDICAID | $133.28 |
| CENCAL HEALTH PLAN | MEDICAID | $133.28 |
| INLAND EMPIRE HEALTH PLAN | MEDICAID | $133.28 |
| KERN FAMILY HEALTH PLAN | MEDICAID | $133.28 |
| CITY OF PHILADELPHIA | MEDICAID | $133.28 |
| COUNTY FUNDING GENERIC | MEDICAID | $133.28 |
| BROWARD COUNTY DEPT OF HEALTH | MEDICAID | $133.28 |
| CMH NORTH COUNTRY | MEDICAID | $133.28 |
| IOWA TOTAL CARE | MEDICAID | $133.28 |
| RX MEDICAID | MEDICAID | $133.28 |
| PEACH STATE HEALTHPLAN | MEDICAID | $133.28 |
| MEDICAID SPENDDOWN | MEDICAID | $133.28 |
| MEDI-CAL HEALTHNET | MEDICAID | $133.28 |
| NASCENTIA HEALTH OPTIONS | MEDICAID | $133.28 |
| MEDICAID - OR | MEDICAID | $135.25 |
| SUNSHINE STATE HEALTH PLAN | SUNSHINE STATE HEALTH MEDICAID | $137.28 |
| WELLCARE MEDICAID | SUNSHINE STATE HEALTH MEDICAID | $137.28 |
| MEDICAID - ID | MEDICAID | $137.38 |
| MEDICAID - ID | MEDICAID | $137.38 |
| WELLCARE MEDICAID | SUNSHINE STATE HEALTH MEDICAID | $139.94 |
| SUNSHINE STATE HEALTH PLAN | SUNSHINE STATE HEALTH MEDICAID | $139.94 |
| MEDICAID - OR | MEDICAID | $142.19 |
| MOLINA MEDICAID | MOLINA MEDICAID | $146.61 |
| MOLINA MEDICAID | MOLINA MEDICAID | $146.61 |
| AVMED HEALTH PLAN | AVMED SELECT NETWORK | $147.64 |
| CAREPLUS HEALTH PLANS | CAREPLUS MEDICARE ADVANTAGE | $153.76 |
| PREFERRED CARE PARTNERS | PREFERRED CARE PARTNERS MEDICARE ADV | $162.80 |
| FIRST HEALTH | FIRST HEALTH INTERNATIONAL | $165.15 |
| FIRST HEALTH | FIRST HEALTH INTERNATIONAL | $165.15 |
| FIRST HEALTH | FIRST HEALTH INTERNATIONAL | $165.15 |
| BLUE CROSS - FL | BCBS TRULI FOR HEALTH | $167.97 |
| MEDICAID - NE | MEDICAID | $169.09 |
| MEDICAID - NE | MEDICAID | $169.09 |
| BLUE CROSS - FL | BCBS TRULI FOR HEALTH | $171.66 |
| TRIWEST HEALTH ALLIANCE | TRICARE | $172.33 |
| TRICARE WEST HEALTHNET | TRICARE | $172.33 |
| TRICARE EAST HUMANA | TRICARE | $172.33 |
| VETERANS EVAL SERVICES | TRICARE | $172.33 |
| TRICARE | TRICARE | $172.33 |
| US FAMILY HEALTH PLAN | TRICARE | $172.33 |
| CHAMPVA | TRICARE | $172.33 |
| VETERANS EVAL SERVICES | TRICARE | $172.33 |
| TRIWEST HEALTH ALLIANCE | TRICARE | $172.33 |
| TRICARE | TRICARE | $172.33 |
| CHAMPVA | TRICARE | $172.33 |
| US FAMILY HEALTH PLAN | TRICARE | $172.33 |
| TRICARE WEST HEALTHNET | TRICARE | $172.33 |
| TRICARE EAST HUMANA | TRICARE | $172.33 |
| MOLINA MEDICAID | MOLINA HEALTHCARE MEDICAID | $177.17 |
| AMERIHEALTH MEDICARE | MEDICARE | $180.89 |
| HORIZON NJ TOTAL CARE | MEDICARE | $180.89 |
| BLUE SHIELD - NY HIGHMARK WESTERN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| MODA HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| GOLD ADVANTAGE | MEDICARE | $180.89 |
| JEFFERSON HEALTH PLANS MEDICARE | MEDICARE | $180.89 |
| ALIGNMENT HEALTH PLAN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| HEALTH PARTNERS MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| HEALTHFIRST MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| ALIGN SENIOR CARE | MEDICARE | $180.89 |
| UNICARE MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| CARE RESOURCES PACE | MEDICARE | $180.89 |
| EDDY SENIORCARE PACE | MEDICARE | $180.89 |
| UM HEALTH ADVANTAGE | MEDICARE | $180.89 |
| COMMUNITY PACE AT HOME | MEDICARE | $180.89 |
| RX GRANE GRNMEDD | MEDICARE | $180.89 |
| LIFECIRCLES PACE | MEDICARE | $180.89 |
| PARAMOUNT MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| PACE SOUTHEAST | MEDICARE | $180.89 |
| UNION HEALTH SERVICE | MEDICARE | $180.89 |
| MERCYONE CEDAR VALLEY | MEDICARE | $180.89 |
| CCA - ZING HEALTH | MEDICARE | $180.89 |
| BCBS MEDICARE ADVANTAGE GENERIC | MEDICARE | $180.89 |
| TOTAL HEALTHCARE MEDICARE SNP | MEDICARE | $180.89 |
| CONNECTICARE VIP MEDICARE | MEDICARE | $180.89 |
| MEDICARE PUERTO RICO | MEDICARE | $180.89 |
| BLUE CROSS - NY (ANTHEM) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| POSITIVE HEALTHCARE PARTNERS MEDICARE | POSITIVE HEALTH PARTNERS MEDICARE ADV | $180.89 |
| HAP EMPOWERED MI HEALTH LINK MEDICARE DUAL | MEDICARE | $180.89 |
| BLUE CROSS - GA (ANTHEM) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - KY (ANTHEM) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - NE MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| TODAYS OPTIONS | MEDICARE | $180.89 |
| COMMONWEALTH CARE ALLIANCE | MEDICARE | $180.89 |
| MEDICARE ALTERNATE PAYOR | MEDICARE | $180.89 |
| RELIANCE COMMUNITY CARE PARTNERS CARE RESOURCES PACE | MEDICARE | $180.89 |
| GENESYS PACE OF GENESEE COUNTY | MEDICARE | $180.89 |
| BLUE CROSS - OH (ANTHEM) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| MEDICARE | MEDICARE | $180.89 |
| AETNA MEDICARE ADVANTAGE | AETNA MEDICARE ADVANTAGE | $180.89 |
| RX MEDICARE | MEDICARE | $180.89 |
| AURORA SPECIAL NEEDS | MEDICARE | $180.89 |
| LIFE ST MARYS PACE | MEDICARE | $180.89 |
| WELLMED | MEDICARE | $180.89 |
| CARE IMPROVEMENT PLUS | MEDICARE | $180.89 |
| BLUE CROSS - IN (ANTHEM) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - CT (ANTHEM) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE SHIELD - PA (HIGHMARK) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| AETNA MEDICARE TRANSPLANT | MEDICARE | $180.89 |
| MARTINS POINT GENERATIONS ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - NY (EXCELLUS) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| TRIBUTE HEALTH PLANS | MEDICARE | $180.89 |
| UNIVERA HEALTHCARE MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| UPMC MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| SUNSHINE HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| TRISTATE BENEFIT SOLUTIONS MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| MCLAREN HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| SELECTHEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| SIMPLY HEALTHCARE MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| HEALTHNET MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| ILLINICARE HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| IMPERIAL HEALTH PLAN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| EON HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| CARECENTRIX MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| CARE DIMENSIONS | MEDICARE | $180.89 |
| MI HEALTHLINK MEDICARE | MEDICARE | $180.89 |
| MOLINA MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| TOTAL COMM CARE MEDICARE REPL | MEDICARE | $180.89 |
| BLUE CROSS - MS MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| ELEMENTCARE | MEDICARE | $180.89 |
| BLUE CROSS - RI MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - TN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| MEDIPAK ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - FL MEDICARE ADVANTAGE | BCBS MEDICARE ADVANTAGE | $180.89 |
| BLUE CROSS - MA MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - IA (WELLMARK) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| TUFTS MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| CAPITAL DISTRICT PHYSICIANS HEALTH PLAN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - WV (HIGHMARK) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| AMERICAN HEALTH ADVANTAGE OF IDAHO | MEDICARE | $180.89 |
| JOHNS HOPKINS ADVANTAGE MD | MEDICARE | $180.89 |
| HAP MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - MN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| HUMANA CENTRAL VALLEY MEDPRO | MEDICARE | $180.89 |
| INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS | MEDICARE | $180.89 |
| ALLY ALIGN CARE ADV | MEDICARE | $180.89 |
| PHP MEDICARE | MEDICARE | $180.89 |
| HIGHMARK WHOLECARE MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| FRESNO PACE MEDICARE | MEDICARE | $180.89 |
| EVERENCE | MEDICARE | $180.89 |
| BLUE CROSS - IL MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| MERCY LIFE | MEDICARE | $180.89 |
| PACE OF SOUTHWEST MICHIGAN | MEDICARE | $180.89 |
| PACE-TRINITY HEALTH | MEDICARE | $180.89 |
| SERENITY PACE | MEDICARE | $180.89 |
| SIOUXLAND PACE | MEDICARE | $180.89 |
| CENTRAL VALLEY MEDICAL SERVICES CORP PACE | MEDICARE | $180.89 |
| BLUE CROSS - PA (INDEPENDENCE) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| HURON VALLEY PACE | MEDICARE | $180.89 |
| PACE CNY | MEDICARE | $180.89 |
| HEALTH AMERICA ADVANTRA | MEDICARE | $180.89 |
| PACIFICSOURCE HEALTH PLANS MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE SHIELD - CA MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - MT MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - NM MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| EDDY SENIOR CARE-PACE | MEDICARE | $180.89 |
| BLUE CROSS - OK MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| SUNNYVIEW-PACE FINANCE DEPT | MEDICARE | $180.89 |
| ALLWELL PA HEALTH & WELLNESS MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| CLEAR SPRING HEALTH | MEDICARE | $180.89 |
| ICARE MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| HUMANA MEDICARE ADVANTAGE | HUMANA MEDICARE ADVANTAGE | $180.89 |
| HUMANA MEDICARE ADVANTAGE | HUMANA MEDICARE ADVANTAGE | $180.89 |
| ADVANTRA FREEDOM MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| KEYSTONE FIRST CHC MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - OR (REGENCE) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| CAREFIRST MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| LONGEVITY IPA OF MICHIGAN LLC HEALTH PLAN ISNP | MEDICARE | $180.89 |
| MICHIGAN COMPLETE HEALTH | MEDICARE | $180.89 |
| OPTIMUM HEALTHCARE MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE SHIELD - NY HIGHMARK NORTHEASTERN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| GEORGIA HEALTH ADVANTAGE | MEDICARE | $180.89 |
| BLUE SHIELD - ID (REGENCE) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| EVERCARE | MEDICARE | $180.89 |
| DEAN HEALTH MEDICARE SELECT | MEDICARE | $180.89 |
| COVENTRY MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - MI MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| ALLWELL MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| PHOENIX MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| CIGNA MEDICARE ADVANTAGE | CIGNA MEDICARE ADVANTAGE | $180.89 |
| BLUE CROSS - WI (ANTHEM) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| MEDICAL MUTUAL MEDICARE | MEDICARE | $180.89 |
| COMMONWEALTH CARE ALLIANCE MEDICARE | MEDICARE | $180.89 |
| SOUTH COUNTRY HEALTH ALLIANCE MEDICARE | MEDICARE | $180.89 |
| MEDICARE ADVANTAGE GENERIC | MEDICARE | $180.89 |
| BLUE SHIELD - DE (HIGHMARK) MEDCIARE ADVANTAGE | MEDICARE | $180.89 |
| CARESOURCE MEDICARE | MEDICARE | $180.89 |
| THE HEALTH PLAN | MEDICARE | $180.89 |
| OSU PRIME CARE ADVANTAGE | MEDICARE | $180.89 |
| MEDIGOLD MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| CARE WISCONSIN MEDICARE | MEDICARE | $180.89 |
| RX CARELONRX MEDICARE | MEDICARE | $180.89 |
| RX RETIREE RX CARE | MEDICARE | $180.89 |
| CHAMPION HEALTH PLAN MCR ADVANTAGE | MEDICARE | $180.89 |
| AETNA MEDICARE ASSURE PREMIER HMO D-SNP | MEDICARE | $180.89 |
| ANTHEM MYCARE OHIO | MEDICARE | $180.89 |
| PERENNIAL ADVANTAGE | MEDICARE | $180.89 |
| HIGHMARK HEALTH OPTIONS DUAL PLAN | MEDICARE | $180.89 |
| OSCAR MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| HEALTH ALLIANCE MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| EMBLEM HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| MEDICA MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| CORE CARE SELECT MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| MERIDIAN COMPLETE | MEDICARE | $180.89 |
| PEAK PACE SOLUTIONS | MEDICARE | $180.89 |
| UNITED HEALTHCARE MEDICARE | UHC MEDICARE ADVANTAGE | $180.89 |
| UCARE MEDICARE | MEDICARE | $180.89 |
| VNSNY CHOICE MEDICARE | MEDICARE | $180.89 |
| BLUE CARE NETWORK ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - ID MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| RX ALLWIN | MEDICARE | $180.89 |
| HEALTH NEW ENGLAND MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BRAND NEW DAY MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| WELLSENSE HEALTH PLAN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - CA (ANTHEM) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| SECURITY HEALTH MEDICARE | MEDICARE | $180.89 |
| NETWORK MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| UPPER PENINSULA HEALTH PLAN (UPHP) MEDICARE | MEDICARE | $180.89 |
| MOLINA MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - NC MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| THOME PACE | MEDICARE | $180.89 |
| HARVARD PILGRIM STRIDE MEDICARE | MEDICARE | $180.89 |
| FREEDOM HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| PROMINENCE MEDICARE | MEDICARE | $180.89 |
| IOWA HEALTH ADVANTAGE | MEDICARE | $180.89 |
| PRIME HEALTH SERVICES MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| MEDICARE MEDICAL ASSOCIATES HEALTH PLANS | MEDICARE | $180.89 |
| MASS GENERAL BRIGHAM MCR ADV | MEDICARE | $180.89 |
| SCAN HEALTH PLAN MCR IPA MERITAGE OON | MEDICARE | $180.89 |
| HUDSON HEADWATERS PACE | MEDICARE | $180.89 |
| AMERICAN HEALTH PLAN | MEDICARE | $180.89 |
| CAREPARTNERS OF CONNECTICUT MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| UNIVERSAL MEDICARE | MEDICARE | $180.89 |
| NASCENTIA HEALTH PLUS | MEDICARE | $180.89 |
| CENTRAL HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| RX ALLWIN | MEDICARE | $180.89 |
| RX MEDICARE PART B | MEDICARE | $180.89 |
| PACE IOWA IMMANUEL PATHWAYS | MEDICARE | $180.89 |
| PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS | MEDICARE | $180.89 |
| CLOVER HEALTH | MEDICARE | $180.89 |
| WELLPOINT MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - TX MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| KAISER PERMANENTE MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| CONNECTICARE VIP MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| PRESBYTERIAN SENIOR PLAN | MEDICARE | $180.89 |
| HUMANA MEDICARE TRANSPLANT | MEDICARE | $180.89 |
| MEDSTAR MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| OPTUM MEDICARE TRANSPLANT | MEDICARE | $180.89 |
| ESSENCE MEDICARE HMO | MEDICARE | $180.89 |
| GPA CROELL REDI MIX | MEDICARE | $180.89 |
| LONGEVITY HEALTH PLAN | MEDICARE | $180.89 |
| BUCKEYE HEALTH PLAN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| LASSO HEALTHCARE MSA | MEDICARE | $180.89 |
| FIDELIS MEDICARE | MEDICARE | $180.89 |
| AVMED MEDICARE | AVMED MEDICARE ADVANTAGE | $180.89 |
| HOPE SELECT PACE | MEDICARE | $180.89 |
| SECURE HORIZONS MA PFFS | MEDICARE | $180.89 |
| HARVARD PILGRIM MEDICARE | MEDICARE | $180.89 |
| MVP MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| CCA SENIOR CARE OPTIONS | MEDICARE | $180.89 |
| PRIORITY HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| GLOBAL MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| TEXAN PLUS | MEDICARE | $180.89 |
| CARELON HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| FALLON HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| PROVIDER PARTNERS HEALTH PLAN OF INDIANA | MEDICARE | $180.89 |
| GATEWAY HEALTH PLAN | MEDICARE | $180.89 |
| PRUITTHEALTH PREMIER | MEDICARE | $180.89 |
| SANFORD HEALTH PLAN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| SCAN HEALTH PLAN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| WELBE HEALTH | MEDICARE | $180.89 |
| FALLON HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| MVP MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| CCA SENIOR CARE OPTIONS | MEDICARE | $180.89 |
| TEXAN PLUS | MEDICARE | $180.89 |
| CARELON HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| FREEDOM HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - NC MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| ESSENCE MEDICARE HMO | MEDICARE | $180.89 |
| THOME PACE | MEDICARE | $180.89 |
| HARVARD PILGRIM STRIDE MEDICARE | MEDICARE | $180.89 |
| MEDSTAR MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| OPTUM MEDICARE TRANSPLANT | MEDICARE | $180.89 |
| UM HEALTH ADVANTAGE | MEDICARE | $180.89 |
| MEDICARE ADVANTAGE GENERIC | MEDICARE | $180.89 |
| BLUE SHIELD - DE (HIGHMARK) MEDCIARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - CA (ANTHEM) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| ALLWELL PA HEALTH & WELLNESS MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| MODA HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - OH (ANTHEM) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| AURORA SPECIAL NEEDS | MEDICARE | $180.89 |
| CARE IMPROVEMENT PLUS | MEDICARE | $180.89 |
| BLUE CROSS - IN (ANTHEM) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| KAISER PERMANENTE MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| CONNECTICARE VIP MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| WELLMED | MEDICARE | $180.89 |
| HARVARD PILGRIM MEDICARE | MEDICARE | $180.89 |
| BLUE CROSS - TX MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| HOPE SELECT PACE | MEDICARE | $180.89 |
| SECURE HORIZONS MA PFFS | MEDICARE | $180.89 |
| PRIORITY HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| GLOBAL MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| OPTIMUM HEALTHCARE MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| MICHIGAN COMPLETE HEALTH | MEDICARE | $180.89 |
| CORE CARE SELECT MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BRAND NEW DAY MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| HEALTHFIRST MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| GOLD ADVANTAGE | MEDICARE | $180.89 |
| HEALTH PARTNERS MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| UNICARE MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| CARE RESOURCES PACE | MEDICARE | $180.89 |
| EDDY SENIORCARE PACE | MEDICARE | $180.89 |
| LIFE ST MARYS PACE | MEDICARE | $180.89 |
| ALIGN SENIOR CARE | MEDICARE | $180.89 |
| MARTINS POINT GENERATIONS ADVANTAGE | MEDICARE | $180.89 |
| WELLSENSE HEALTH PLAN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE SHIELD - NY HIGHMARK WESTERN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| HEALTHNET MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| AMERICAN HEALTH PLAN | MEDICARE | $180.89 |
| IOWA HEALTH ADVANTAGE | MEDICARE | $180.89 |
| CENTRAL HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| MASS GENERAL BRIGHAM MCR ADV | MEDICARE | $180.89 |
| SCAN HEALTH PLAN MCR IPA MERITAGE OON | MEDICARE | $180.89 |
| UNIVERSAL MEDICARE | MEDICARE | $180.89 |
| NASCENTIA HEALTH PLUS | MEDICARE | $180.89 |
| COMMUNITY PACE AT HOME | MEDICARE | $180.89 |
| RX GRANE GRNMEDD | MEDICARE | $180.89 |
| RX CARELONRX MEDICARE | MEDICARE | $180.89 |
| RX RETIREE RX CARE | MEDICARE | $180.89 |
| MI HEALTHLINK MEDICARE | MEDICARE | $180.89 |
| BLUE CROSS - RI MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| CARE DIMENSIONS | MEDICARE | $180.89 |
| BLUE CROSS - MA MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - MS MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| ELEMENTCARE | MEDICARE | $180.89 |
| MEDIPAK ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - FL MEDICARE ADVANTAGE | BCBS MEDICARE ADVANTAGE | $180.89 |
| JOHNS HOPKINS ADVANTAGE MD | MEDICARE | $180.89 |
| BLUE CROSS - TN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - IA (WELLMARK) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| CAREPARTNERS OF CONNECTICUT MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| AETNA MEDICARE ASSURE PREMIER HMO D-SNP | MEDICARE | $180.89 |
| ANTHEM MYCARE OHIO | MEDICARE | $180.89 |
| PROMINENCE MEDICARE | MEDICARE | $180.89 |
| CHAMPION HEALTH PLAN MCR ADVANTAGE | MEDICARE | $180.89 |
| PERENNIAL ADVANTAGE | MEDICARE | $180.89 |
| FIDELIS MEDICARE | MEDICARE | $180.89 |
| CAREPLUS HEALTH PLANS | CAREPLUS MEDICARE ADVANTAGE | $180.89 |
| AVMED MEDICARE | AVMED MEDICARE ADVANTAGE | $180.89 |
| BLUE CROSS - IL MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - MN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| AETNA MEDICARE ADVANTAGE | AETNA MEDICARE ADVANTAGE | $180.89 |
| MEDICARE | MEDICARE | $180.89 |
| SOUTH COUNTRY HEALTH ALLIANCE MEDICARE | MEDICARE | $180.89 |
| PACE IOWA IMMANUEL PATHWAYS | MEDICARE | $180.89 |
| PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS | MEDICARE | $180.89 |
| COMMONWEALTH CARE ALLIANCE MEDICARE | MEDICARE | $180.89 |
| HIGHMARK HEALTH OPTIONS DUAL PLAN | MEDICARE | $180.89 |
| PRIME HEALTH SERVICES MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| MEDICARE MEDICAL ASSOCIATES HEALTH PLANS | MEDICARE | $180.89 |
| HUDSON HEADWATERS PACE | MEDICARE | $180.89 |
| TUFTS MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| ALLWELL MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| ADVANTRA FREEDOM MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - MI MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| CIGNA MEDICARE ADVANTAGE | CIGNA MEDICARE ADVANTAGE | $180.89 |
| COVENTRY MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| PHOENIX MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CARE NETWORK ADVANTAGE | MEDICARE | $180.89 |
| RX MEDICARE PART B | MEDICARE | $180.89 |
| RX ALLWIN | MEDICARE | $180.89 |
| RX ALLWIN | MEDICARE | $180.89 |
| GPA CROELL REDI MIX | MEDICARE | $180.89 |
| TOTAL HEALTHCARE MEDICARE SNP | MEDICARE | $180.89 |
| CONNECTICARE VIP MEDICARE | MEDICARE | $180.89 |
| BLUE CROSS - NY (ANTHEM) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| POSITIVE HEALTHCARE PARTNERS MEDICARE | POSITIVE HEALTH PARTNERS MEDICARE ADV | $180.89 |
| BLUE CROSS - NE MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| TODAYS OPTIONS | MEDICARE | $180.89 |
| UPMC MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - GA (ANTHEM) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - KY (ANTHEM) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - WI (ANTHEM) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| MOLINA MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| CLEAR SPRING HEALTH | MEDICARE | $180.89 |
| ICARE MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| HUMANA MEDICARE ADVANTAGE | HUMANA MEDICARE ADVANTAGE | $180.89 |
| HUMANA MEDICARE ADVANTAGE | HUMANA MEDICARE ADVANTAGE | $180.89 |
| DEAN HEALTH MEDICARE SELECT | MEDICARE | $180.89 |
| CLOVER HEALTH | MEDICARE | $180.89 |
| AMERIHEALTH MEDICARE | MEDICARE | $180.89 |
| LONGEVITY HEALTH PLAN | MEDICARE | $180.89 |
| UNIVERA HEALTHCARE MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| CAREFIRST MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| LASSO HEALTHCARE MSA | MEDICARE | $180.89 |
| PACE SOUTHEAST | MEDICARE | $180.89 |
| BCBS MEDICARE ADVANTAGE GENERIC | MEDICARE | $180.89 |
| LIFECIRCLES PACE | MEDICARE | $180.89 |
| PARAMOUNT MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| MERCYONE CEDAR VALLEY | MEDICARE | $180.89 |
| CCA - ZING HEALTH | MEDICARE | $180.89 |
| UCARE MEDICARE | MEDICARE | $180.89 |
| UNITED HEALTHCARE MEDICARE | UHC MEDICARE ADVANTAGE | $180.89 |
| SECURITY HEALTH MEDICARE | MEDICARE | $180.89 |
| UPPER PENINSULA HEALTH PLAN (UPHP) MEDICARE | MEDICARE | $180.89 |
| NETWORK MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| PACIFICSOURCE HEALTH PLANS MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| VNSNY CHOICE MEDICARE | MEDICARE | $180.89 |
| BLUE CROSS - ID MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| MEDICARE PUERTO RICO | MEDICARE | $180.89 |
| UNION HEALTH SERVICE | MEDICARE | $180.89 |
| HAP EMPOWERED MI HEALTH LINK MEDICARE DUAL | MEDICARE | $180.89 |
| HURON VALLEY PACE | MEDICARE | $180.89 |
| PACE CNY | MEDICARE | $180.89 |
| PACE-TRINITY HEALTH | MEDICARE | $180.89 |
| CENTRAL VALLEY MEDICAL SERVICES CORP PACE | MEDICARE | $180.89 |
| BLUE CROSS - PA (INDEPENDENCE) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| KEYSTONE FIRST CHC MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| HEALTH AMERICA ADVANTRA | MEDICARE | $180.89 |
| LONGEVITY IPA OF MICHIGAN LLC HEALTH PLAN ISNP | MEDICARE | $180.89 |
| BUCKEYE HEALTH PLAN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| HAP MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| MEDICAL MUTUAL MEDICARE | MEDICARE | $180.89 |
| CARESOURCE MEDICARE | MEDICARE | $180.89 |
| MEDIGOLD MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| CARE WISCONSIN MEDICARE | MEDICARE | $180.89 |
| THE HEALTH PLAN | MEDICARE | $180.89 |
| OSU PRIME CARE ADVANTAGE | MEDICARE | $180.89 |
| MERIDIAN COMPLETE | MEDICARE | $180.89 |
| PEAK PACE SOLUTIONS | MEDICARE | $180.89 |
| HORIZON NJ TOTAL CARE | MEDICARE | $180.89 |
| BLUE CROSS - OR (REGENCE) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS | MEDICARE | $180.89 |
| FRESNO PACE MEDICARE | MEDICARE | $180.89 |
| PHP MEDICARE | MEDICARE | $180.89 |
| HIGHMARK WHOLECARE MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| SIOUXLAND PACE | MEDICARE | $180.89 |
| MERCY LIFE | MEDICARE | $180.89 |
| PACE OF SOUTHWEST MICHIGAN | MEDICARE | $180.89 |
| SERENITY PACE | MEDICARE | $180.89 |
| ILLINICARE HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| IMPERIAL HEALTH PLAN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| EON HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| HEALTH ALLIANCE MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| MEDICA MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| COMMONWEALTH CARE ALLIANCE | MEDICARE | $180.89 |
| GENESYS PACE OF GENESEE COUNTY | MEDICARE | $180.89 |
| MEDICARE ALTERNATE PAYOR | MEDICARE | $180.89 |
| PRUITTHEALTH PREMIER | MEDICARE | $180.89 |
| ALIGNMENT HEALTH PLAN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| SCAN HEALTH PLAN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| JEFFERSON HEALTH PLANS MEDICARE | MEDICARE | $180.89 |
| HUMANA CENTRAL VALLEY MEDPRO | MEDICARE | $180.89 |
| WELBE HEALTH | MEDICARE | $180.89 |
| EMBLEM HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| HEALTH NEW ENGLAND MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| RX MEDICARE | MEDICARE | $180.89 |
| SUNSHINE HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| RELIANCE COMMUNITY CARE PARTNERS CARE RESOURCES PACE | MEDICARE | $180.89 |
| ALLY ALIGN CARE ADV | MEDICARE | $180.89 |
| PROVIDER PARTNERS HEALTH PLAN OF INDIANA | MEDICARE | $180.89 |
| SANFORD HEALTH PLAN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| TRISTATE BENEFIT SOLUTIONS MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| SELECTHEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| SIMPLY HEALTHCARE MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| MCLAREN HEALTH MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| EDDY SENIOR CARE-PACE | MEDICARE | $180.89 |
| GATEWAY HEALTH PLAN | MEDICARE | $180.89 |
| AETNA MEDICARE TRANSPLANT | MEDICARE | $180.89 |
| WELLPOINT MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| HUMANA MEDICARE TRANSPLANT | MEDICARE | $180.89 |
| BLUE CROSS - CT (ANTHEM) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE SHIELD - PA (HIGHMARK) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - NY (EXCELLUS) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| TRIBUTE HEALTH PLANS | MEDICARE | $180.89 |
| CARECENTRIX MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| MOLINA MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| TOTAL COMM CARE MEDICARE REPL | MEDICARE | $180.89 |
| PRESBYTERIAN SENIOR PLAN | MEDICARE | $180.89 |
| BLUE CROSS - MT MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - NM MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE CROSS - OK MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| SUNNYVIEW-PACE FINANCE DEPT | MEDICARE | $180.89 |
| OSCAR MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| PREFERRED CARE PARTNERS | PREFERRED CARE PARTNERS MEDICARE ADV | $180.89 |
| CAPITAL DISTRICT PHYSICIANS HEALTH PLAN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| AMERICAN HEALTH ADVANTAGE OF IDAHO | MEDICARE | $180.89 |
| BLUE CROSS - WV (HIGHMARK) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| EVERENCE | MEDICARE | $180.89 |
| BLUE SHIELD - CA MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| BLUE SHIELD - NY HIGHMARK NORTHEASTERN MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| GEORGIA HEALTH ADVANTAGE | MEDICARE | $180.89 |
| BLUE SHIELD - ID (REGENCE) MEDICARE ADVANTAGE | MEDICARE | $180.89 |
| EVERCARE | MEDICARE | $180.89 |
| AMBETTER | AMBETTER | $183.99 |
| VETERANS ADMINISTRATION | VETERANS AFFAIRS | $184.58 |
| NEW CENTRY HEALTH CAREPLUS | NEW CENTURY HEALTH MEDICARE ADVANTAGE | $184.58 |
| NEW CENTRY HEALTH CAREPLUS | NEW CENTURY HEALTH MEDICARE ADVANTAGE | $184.58 |
| VETERANS ADMINISTRATION | VETERANS AFFAIRS | $184.58 |
| GOLD KIDNEY MEDICARE | GOLD KIDNEY MEDICARE ADVANTAGE | $188.27 |
| GOLD KIDNEY MEDICARE | GOLD KIDNEY MEDICARE ADVANTAGE | $188.27 |
| HEALTHSUN MEDICARE ADVANTAGE | HEALTHSUN MEDICARE ADVANTAGE | $189.93 |
| SOLIS HEALTH PLANS | SOLIS HEALTH PLANS MEDICARE ADVANTAGE | $189.93 |
| WELLCARE MEDICARE | WELLCARE MEDICARE ADVANTAGE | $189.93 |
| HEALTHSUN MEDICARE ADVANTAGE | HEALTHSUN MEDICARE ADVANTAGE | $189.93 |
| WELLCARE MEDICARE | WELLCARE MEDICARE ADVANTAGE | $189.93 |
| SOLIS HEALTH PLANS | SOLIS HEALTH PLANS MEDICARE ADVANTAGE | $189.93 |
| DEVOTED HEALTH MEDICARE ADVANTAGE | DEVOTED HEALTH MEDICARE ADVANTAGE | $193.81 |
| DEVOTED HEALTH MEDICARE ADVANTAGE | DEVOTED HEALTH MEDICARE ADVANTAGE | $193.81 |
| CIGNA | CIGNA SUREFIT | $203.37 |
| CIGNA | CIGNA SUREFIT | $203.37 |
| BLUE CROSS - FL | BCBS HEALTH OPTIONS | $203.94 |
| BRIDGE HEALTH | BRIDGE HEALTH MEDICAL | $206.96 |
| BRIDGE HEALTH | BRIDGE HEALTH MEDICAL | $206.96 |
| BRIDGE HEALTH | BRIDGE HEALTH MEDICAL | $206.96 |
| BLUE CROSS - FL | BCBS HEALTH OPTIONS | $207.65 |
| AETNA | AETNA GLOBAL BENEFITS | $207.79 |
| AETNA | AETNA GLOBAL BENEFITS | $207.79 |
| AETNA | AETNA GLOBAL BENEFITS | $207.79 |
| AVMED HEALTH PLAN | AVMED SELECT | $211.96 |
| AVMED HEALTH PLAN | AVMED MARKETPLACE | $211.96 |
| AVMED HEALTH PLAN | AVMED SELECT | $215.56 |
| AVMED HEALTH PLAN | AVMED MARKETPLACE | $215.56 |
| AVMED HEALTH PLAN | AVMED | $219.15 |
| AMBETTER | AMBETTER | $220.06 |
| MOLINA MARKETPLACE | MOLINA MARKETPLACE | $221.50 |
| MOLINA MARKETPLACE | MOLINA MARKETPLACE | $221.50 |
| AVMED HEALTH PLAN | AVMED | $222.74 |
| COMMUNITY CARE PLAN | MEMORIAL HEALTH SYSTEM | $223.19 |
| MEMORIAL INTEGRATED HEALTH | MEMORIAL HEALTH SYSTEM | $223.19 |
| COMMUNITY CARE PLAN | MEMORIAL HEALTH SYSTEM | $223.19 |
| MEMORIAL INTEGRATED HEALTH | MEMORIAL HEALTH SYSTEM | $223.19 |
| COMMUNITY CARE PLAN | MEMORIAL HEALTH SYSTEM | $223.19 |
| MEMORIAL INTEGRATED HEALTH | MEMORIAL HEALTH SYSTEM | $223.19 |
| GEHA | UNITED HEALTHCARE | $225.66 |
| UNITED HEALTHCARE | UNITED HEALTHCARE | $225.66 |
| UNITED HEALTHCARE | UHC OPTIONS PPO | $225.66 |
| GEHA | UNITED HEALTHCARE | $225.66 |
| UNITED HEALTHCARE | UNITED HEALTHCARE | $225.66 |
| UNITED HEALTHCARE | UHC OPTIONS PPO | $225.66 |
| UPMC HEALTH PLAN | CIGNA | $225.98 |
| CIGNA | CIGNA | $225.98 |
| UPMC HEALTH PLAN | CIGNA | $225.98 |
| CIGNA | CIGNA | $225.98 |
| WC BROWARD COUNTY | WORKERS COMP | $227.16 |
| WC CORVEL | WORKERS COMP | $227.16 |
| WC CORVEL | WORKERS COMP | $227.16 |
| WC BROWARD COUNTY | WORKERS COMP | $227.16 |
| WC CORVEL | WORKERS COMP | $227.16 |
| WC BROWARD COUNTY | WORKERS COMP | $227.16 |
| WC CORVEL | WORKERS COMP | $227.16 |
| WC BROWARD COUNTY | WORKERS COMP | $227.16 |
| WC CORVEL | WORKERS COMP | $227.16 |
| WC BROWARD COUNTY | WORKERS COMP | $227.16 |
| MEMORIAL INTEGRATED HEALTH | MEMORIAL INTEGRATED HEALTH | $230.32 |
| COMMUNITY CARE PLAN | MEMORIAL INTEGRATED HEALTH | $230.32 |
| BLUE CROSS - FL | BCBS NETWORK BLUE | $231.75 |
| WC HERITAGE SUMMIT | WORKERS COMP | $231.94 |
| WC HERITAGE SUMMIT | WORKERS COMP | $231.94 |
| WC HERITAGE SUMMIT | WORKERS COMP | $231.94 |
| WC HERITAGE SUMMIT | WORKERS COMP | $231.94 |
| WC HERITAGE SUMMIT | WORKERS COMP | $231.94 |
| HUMANA | HUMANA | $232.20 |
| HUMANA | HUMANA | $232.20 |
| AETNA | AETNA | $234.93 |
| AETNA | AETNA GLOBAL | $234.93 |
| AETNA DOMESTIC | AETNA | $234.93 |
| MERITAIN | AETNA | $234.93 |
| FIRST HEALTH | AETNA | $234.93 |
| COVENTRY | AETNA | $234.93 |
| MERITAIN | AETNA | $234.93 |
| AETNA | AETNA | $234.93 |
| AETNA | AETNA GLOBAL | $234.93 |
| COVENTRY | AETNA | $234.93 |
| FIRST HEALTH | AETNA | $234.93 |
| AETNA DOMESTIC | AETNA | $234.93 |
| FIRST HEALTH | FIRST HEALTH INTERNATIONAL | $235.63 |
| BLUE CROSS - FL | BCBS NETWORK BLUE | $237.31 |
| OSCAR | OSCAR | $239.95 |
| OSCAR | OSCAR | $239.95 |
| EMBLEM HEALTH | FIRST HEALTH | $242.97 |
| CONNECTICARE | FIRST HEALTH | $242.97 |
| FIRST HEALTH | FIRST HEALTH | $242.97 |
| CONNECTICARE | FIRST HEALTH | $242.97 |
| EMBLEM HEALTH | FIRST HEALTH | $242.97 |
| FIRST HEALTH | FIRST HEALTH | $242.97 |
| FIRST HEALTH | FIRST HEALTH | $242.97 |
| EMBLEM HEALTH | FIRST HEALTH | $242.97 |
| CONNECTICARE | FIRST HEALTH | $242.97 |
| QUALITY HEALTH MANAGEMENT | INTERNATIONAL | $248.35 |
| AXIS SERVICES | INTERNATIONAL | $248.35 |
| GLOBAL MEDICAL MANAGEMENT | INTERNATIONAL | $248.35 |
| CMN GLOBAL | INTERNATIONAL | $248.35 |
| AXA ASSISTANCE US | INTERNATIONAL | $248.35 |
| GLOBAL HEALTH CLAIM SERVICES | INTERNATIONAL | $248.35 |
| GLOBAL BENEFITS GROUP | GLOBAL BENEFITS PLAN | $248.35 |
| PENFIELD CARE | INTERNATIONAL | $248.35 |
| SANUS HEALTHCARE | SANUS HEALTH MAINTENANCE ADMINISTRATORS | $248.35 |
| NATIONAL HEALTHCARE SOLUTIONS | INTERNATIONAL | $248.35 |
| MORGAN WHITE ADMINISTRATORS | MORGAN WHITE ADMINISTRATORS | $248.35 |
| DESJARDINS FINANCIAL SECURITY LIFE ASSURANCE | INTERNATIONAL | $248.35 |
| ALLIANZ GLOBAL ASSISTANCE | INTERNATIONAL | $248.35 |
| OLYMPUS MANAGED HEALTH CARE | INTERNATIONAL | $248.35 |
| WW CONCIERGE HEALTHCARE SERVICE | INTERNATIONAL | $248.35 |
| GUARDIAN | INTERNATIONAL | $248.35 |
| WW CONCIERGE HEALTHCARE SERVICE | INTERNATIONAL | $248.35 |
| OLYMPUS MANAGED HEALTH CARE | INTERNATIONAL | $248.35 |
| AXA ASSISTANCE US | INTERNATIONAL | $248.35 |
| GLOBAL HEALTH CLAIM SERVICES | INTERNATIONAL | $248.35 |
| SANUS HEALTHCARE | SANUS HEALTH MAINTENANCE ADMINISTRATORS | $248.35 |
| AXIS SERVICES | INTERNATIONAL | $248.35 |
| QUALITY HEALTH MANAGEMENT | INTERNATIONAL | $248.35 |
| NATIONAL HEALTHCARE SOLUTIONS | INTERNATIONAL | $248.35 |
| MORGAN WHITE ADMINISTRATORS | MORGAN WHITE ADMINISTRATORS | $248.35 |
| DESJARDINS FINANCIAL SECURITY LIFE ASSURANCE | INTERNATIONAL | $248.35 |
| GUARDIAN | INTERNATIONAL | $248.35 |
| CMN GLOBAL | INTERNATIONAL | $248.35 |
| GLOBAL MEDICAL MANAGEMENT | INTERNATIONAL | $248.35 |
| PENFIELD CARE | INTERNATIONAL | $248.35 |
| GLOBAL BENEFITS GROUP | GLOBAL BENEFITS PLAN | $248.35 |
| ALLIANZ GLOBAL ASSISTANCE | INTERNATIONAL | $248.35 |
| CMN GLOBAL | INTERNATIONAL | $248.35 |
| GLOBAL MEDICAL MANAGEMENT | INTERNATIONAL | $248.35 |
| GUARDIAN | INTERNATIONAL | $248.35 |
| AXA ASSISTANCE US | INTERNATIONAL | $248.35 |
| GLOBAL HEALTH CLAIM SERVICES | INTERNATIONAL | $248.35 |
| ALLIANZ GLOBAL ASSISTANCE | INTERNATIONAL | $248.35 |
| AXIS SERVICES | INTERNATIONAL | $248.35 |
| QUALITY HEALTH MANAGEMENT | INTERNATIONAL | $248.35 |
| GLOBAL BENEFITS GROUP | GLOBAL BENEFITS PLAN | $248.35 |
| PENFIELD CARE | INTERNATIONAL | $248.35 |
| SANUS HEALTHCARE | SANUS HEALTH MAINTENANCE ADMINISTRATORS | $248.35 |
| NATIONAL HEALTHCARE SOLUTIONS | INTERNATIONAL | $248.35 |
| MORGAN WHITE ADMINISTRATORS | MORGAN WHITE ADMINISTRATORS | $248.35 |
| DESJARDINS FINANCIAL SECURITY LIFE ASSURANCE | INTERNATIONAL | $248.35 |
| OLYMPUS MANAGED HEALTH CARE | INTERNATIONAL | $248.35 |
| WW CONCIERGE HEALTHCARE SERVICE | INTERNATIONAL | $248.35 |
| BLUE CROSS - KS | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - MO (ANTHEM) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - IL ALTERNATE | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - MI | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - IN (ANTHEM) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - MN | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - IA (WELLMARK) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - IL | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - WI (ANTHEM) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - DE (HIGHMARK) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - DC (CAREFIRST) | BCBS PPO TRAD | $248.44 |
| BLUE SHIELD - CA | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - CO (ANTHEM) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - AR | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - CA (ANTHEM) | BCBS PPO TRAD | $248.44 |
| BLUE DISTINCTION TRANSPLANT | BCBS PPO TRAD | $248.44 |
| BLUE BENEFIT ADMINISTRATORS OF MASSACHUSETTS | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - AK (PREMERA) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - AZ | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - OH (ANTHEM) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - SD (WELLMARK) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - AL | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - ND | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - NE | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - MA | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - KY (ANTHEM) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - LA | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - ID | BCBS PPO TRAD | $248.44 |
| BLUE SHIELD - ID (REGENCE) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - GA (ANTHEM) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - HI | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - FL | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - CT (ANTHEM) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - OR (REGENCE) | BCBS PPO TRAD | $248.44 |
| BLUE SHIELD - NY HIGHMARK NORTHEASTERN | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - NC | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - NY (ANTHEM) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - NY (EXCELLUS) | BCBS PPO TRAD | $248.44 |
| BLUE SHIELD - NY HIGHMARK WESTERN | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - NJ (HORIZON) | BCBS PPO TRAD | $248.44 |
| KAISER DOMESTIC | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - NM | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - NV (ANTHEM) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - NH (ANTHEM) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - MS | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - MT | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - ME (ANTHEM) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - MD (CAREFIRST) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - VA (ANTHEM) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - VA (CAREFIRST) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - WA (PREMERA) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - UT (REGENCE) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - VT | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - SC | BCBS PPO TRAD | $248.44 |
| HEALTH CHOICES | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - TN | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - TX | BCBS PPO TRAD | $248.44 |
| BLUE SHIELD - PA (HIGHMARK) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - RI | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - PA (INDEPENDENCE) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - PA (CAPITAL) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - OK | BCBS PPO TRAD | $248.44 |
| BLUE CROSS DOMESTIC | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - FEDERAL | BCBS PPO TRAD | $248.44 |
| BCBS GENERIC | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - WV (HIGHMARK) | BCBS PPO TRAD | $248.44 |
| BLUE CROSS - WY | BCBS PPO TRAD | $248.44 |
| BLUE SHIELD - WA (REGENCE) | BCBS PPO TRAD | $248.44 |
| BCN DOMESTIC | BCBS PPO TRAD | $248.44 |
| BLUE CARE NETWORK | BCBS PPO TRAD | $248.44 |
| WC DOMESTIC | BCBS PPO TRAD | $248.44 |
| PRE-EMPLOYMENT | BCBS PPO TRAD | $248.44 |
| PRE-EMPLOYMENT | BCBS PPO TRAD | $255.85 |
| WC DOMESTIC | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - KS | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - WI (ANTHEM) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - MN | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - IL ALTERNATE | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - IA (WELLMARK) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - IL | BCBS PPO TRAD | $255.85 |
| BCN DOMESTIC | BCBS PPO TRAD | $255.85 |
| BLUE CROSS DOMESTIC | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - NH (ANTHEM) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - NJ (HORIZON) | BCBS PPO TRAD | $255.85 |
| KAISER DOMESTIC | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - NM | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - MS | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - MT | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - LA | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - ME (ANTHEM) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - MD (CAREFIRST) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - MA | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - FL | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - CT (ANTHEM) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - DE (HIGHMARK) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - ID | BCBS PPO TRAD | $255.85 |
| BLUE SHIELD - ID (REGENCE) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - KY (ANTHEM) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - GA (ANTHEM) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - HI | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - WY | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - FEDERAL | BCBS PPO TRAD | $255.85 |
| BCBS GENERIC | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - WA (PREMERA) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - DC (CAREFIRST) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - CA (ANTHEM) | BCBS PPO TRAD | $255.85 |
| BLUE SHIELD - CA | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - CO (ANTHEM) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - AK (PREMERA) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - AZ | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - AR | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - OH (ANTHEM) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - SD (WELLMARK) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - AL | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - MO (ANTHEM) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - ND | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - NE | BCBS PPO TRAD | $255.85 |
| BLUE DISTINCTION TRANSPLANT | BCBS PPO TRAD | $255.85 |
| BLUE BENEFIT ADMINISTRATORS OF MASSACHUSETTS | BCBS PPO TRAD | $255.85 |
| HEALTH CHOICES | BCBS PPO TRAD | $255.85 |
| BLUE SHIELD - WA (REGENCE) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - WV (HIGHMARK) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - VT | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - VA (ANTHEM) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - VA (CAREFIRST) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - TN | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - TX | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - UT (REGENCE) | BCBS PPO TRAD | $255.85 |
| BLUE SHIELD - PA (HIGHMARK) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - RI | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - SC | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - OR (REGENCE) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - PA (INDEPENDENCE) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - MI | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - IN (ANTHEM) | BCBS PPO TRAD | $255.85 |
| BLUE SHIELD - NY HIGHMARK WESTERN | BCBS PPO TRAD | $255.85 |
| BLUE SHIELD - NY HIGHMARK NORTHEASTERN | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - NC | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - OK | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - NY (ANTHEM) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - NY (EXCELLUS) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - NV (ANTHEM) | BCBS PPO TRAD | $255.85 |
| BLUE CROSS - PA (CAPITAL) | BCBS PPO TRAD | $255.85 |
| BLUE CARE NETWORK | BCBS PPO TRAD | $255.85 |
| SUNMED INTERNATIONAL | SUNMED INTERNATIONAL | $256.63 |
| SUNMED INTERNATIONAL | SUNMED INTERNATIONAL | $256.63 |
| SUNMED INTERNATIONAL | SUNMED INTERNATIONAL | $256.63 |
| MULTIPLAN | BEECH STREET | $256.90 |
| CURATIVE | CURATIVE FL | $258.41 |
| CENTIVO | CENTIVO | $258.41 |
| CURATIVE | CURATIVE FL | $258.41 |
| CENTIVO | CENTIVO | $258.41 |
| INTERNATIONAL GENERIC | STAR HEALTHCARE NETWORK PPO | $269.05 |
| INTERNATIONAL GENERIC | STAR HEALTHCARE NETWORK PPO | $269.05 |
| INTERNATIONAL GENERIC | STAR HEALTHCARE NETWORK PPO | $269.05 |
| PHCS | PHCS | $276.87 |
| MULTIPLAN | MULTIPLAN | $276.87 |
| PHCS | PHCS | $276.87 |
| MULTIPLAN | MULTIPLAN | $276.87 |
| UNICARE | PHCS | $289.74 |
| PHCS | PHCS | $289.74 |
| PHCS | PHCS | $289.74 |
| UNICARE | PHCS | $289.74 |
| UNICARE | PHCS | $289.74 |
| PHCS | PHCS | $289.74 |
| SANUS HEALTHCARE | INTERNATIONAL | $293.60 |
| SUNMED INTERNATIONAL | INTERNATIONAL | $293.60 |
| NATIONAL HEALTHCARE SOLUTIONS | INTERNATIONAL | $293.60 |
| ALLIANZ GLOBAL ASSISTANCE | INTERNATIONAL | $293.60 |
| OLYMPUS MANAGED HEALTH CARE | INTERNATIONAL | $293.60 |
| WW CONCIERGE HEALTHCARE SERVICE | INTERNATIONAL | $293.60 |
| GLOBAL HEALTH CLAIM SERVICES | INTERNATIONAL | $293.60 |
| AXA ASSISTANCE US | INTERNATIONAL | $293.60 |
| PENFIELD CARE | INTERNATIONAL | $293.60 |
| GLOBAL BENEFITS GROUP | INTERNATIONAL | $293.60 |
| MORGAN WHITE ADMINISTRATORS | INTERNATIONAL | $293.60 |
| DESJARDINS FINANCIAL SECURITY LIFE ASSURANCE | INTERNATIONAL | $293.60 |
| AXIS SERVICES | INTERNATIONAL | $293.60 |
| STAR HEALTHCARE NETWORK | INTERNATIONAL | $293.60 |
| SELECTCARE WORLDWIDE | INTERNATIONAL | $293.60 |
| BRIDGE HEALTH | BRIDGE HEALTH MEDICAL | $295.28 |
| AETNA | AETNA GLOBAL BENEFITS | $296.46 |
| WC BROWARD COUNTY | BROWARD COUNTY WORKERS COMP | $305.90 |
| WC CORVEL | WC CORVEL | $305.90 |
| WC BROWARD COUNTY | BROWARD COUNTY WORKERS COMP | $305.90 |
| WC CORVEL | WC CORVEL | $305.90 |
| WC HERITAGE SUMMIT | HERITAGE SUMMIT WORKERS COMP | $312.34 |
| WC HERITAGE SUMMIT | HERITAGE SUMMIT WORKERS COMP | $312.34 |
| MEMORIAL INTEGRATED HEALTH | MEMORIAL HEALTH SYSTEM | $318.43 |
| COMMUNITY CARE PLAN | MEMORIAL HEALTH SYSTEM | $318.43 |
| WC CITY OF ALBANY | WORKERS COMP | $322 |
| WC ALIGN NETWORK | WORKERS COMP | $322 |
| WC HORIZON | WORKERS COMP | $322 |
| WC WINNEBAGO INDUSTRIES | WORKERS COMP | $322 |
| WC FIRST AGENCY/OCCUNET | WORKERS COMP | $322 |
| WC GENERAL MOTORS | WORKERS COMP | $322 |
| WC ALLIED | WORKERS COMP | $322 |
| WC EMPLOYEE MUTUAL | WORKERS COMP | $322 |
| WC BENETECH | WORKERS COMP | $322 |
| ANDRIE INC | WORKERS COMP | $322 |
| NEW YORK STATE INSURANCE FUND | WORKERS COMP | $322 |
| WC MASSACHUSETTS | WORKERS COMP | $322 |
| WC RISICO | WORKERS COMP | $322 |
| JAG SOURCE | WORKERS COMP | $322 |
| NJM INSURANCE GROUP | WORKERS COMP | $322 |
| WC IDAHO STATE INS FUND | WORKERS COMP | $322 |
| RX HEATLHCOMP | WORKERS COMP | $322 |
| RX RESTAT | WORKERS COMP | $322 |
| WC TYSON | WORKERS COMP | $322 |
| WC MEADOWBROOK CLAIM | WORKERS COMP | $322 |
| WC MEIJERS | WORKERS COMP | $322 |
| WC FEDERAL BLACK LUNG | WORKERS COMP | $322 |
| WC MITCHELL FRANKENMUTH | WORKERS COMP | $322 |
| WC ASU RISK MGT | WORKERS COMP | $322 |
| WC TACONIC (MRO) | WORKERS COMP | $322 |
| WC NORTHEAST HEALTH | WORKERS COMP | $322 |
| WC PRICE CHOPPER | WORKERS COMP | $322 |
| WC SHEAKLEY UNICOMP | WORKERS COMP | $322 |
| WC SMILE LODGE | WORKERS COMP | $322 |
| WC MEDICAL ADMINISTRATORS | WORKERS COMP | $322 |
| WC NCA COMP | WORKERS COMP | $322 |
| WC NEW YORK | WORKERS COMP | $322 |
| WC NEW YORK SPECIAL FUNDS | WORKERS COMP | $322 |
| RX WORKER'S COMP | WORKERS COMP | $322 |
| WC GENERIC | WORKERS COMP | $322 |
| WC SEDGWICK | WORKERS COMP | $322 |
| WC WEST BEND MUTUAL/ARGENT | WORKERS COMP | $322 |
| WC MEMIC | WORKERS COMP | $322 |
| WC SOCIETY | WORKERS COMP | $322 |
| WC ONE CALL MEDICAL | WORKERS COMP | $322 |
| WC CIRMA | WORKERS COMP | $322 |
| WC UNITED HEARTLAND | WORKERS COMP | $322 |
| WC EMC INSURANCE COMPANY | WORKERS COMP | $322 |
| WC US DEPT OF LABOR | WORKERS COMP | $322 |
| WC NOVANET | WORKERS COMP | $322 |
| WC CNA | WORKERS COMP | $322 |
| WC BROADSPIRE | WORKERS COMP | $322 |
| WC CHUBB | WORKERS COMP | $322 |
| WC WALMART | WORKERS COMP | $322 |
| WC TACONIC FARMS | WORKERS COMP | $322 |
| WC TRIAD GROUP | WORKERS COMP | $322 |
| WC ACS FEDERAL EMPLOYEES | WORKERS COMP | $322 |
| WC EVOLUTIONS | WORKERS COMP | $322 |
| WC NORTH AMERICAN RISHCES | WORKERS COMP | $322 |
| WC CHARTIS | WORKERS COMP | $322 |
| WC GUARD INSURANCE COMPANY | WORKERS COMP | $322 |
| WC AMERISURE | WORKERS COMP | $322 |
| WC ZENITH | WORKERS COMP | $322 |
| WC AMTRUST | WORKERS COMP | $322 |
| WC ENABLECOMP | WORKERS COMP | $322 |
| WC JOHNS EASTERN | WORKERS COMP | $322 |
| WC FCCI | WORKERS COMP | $322 |
| WC UNIFIED HEALTH SERVICES | WORKERS COMP | $322 |
| WC SENTRY | WORKERS COMP | $322 |
| WC PMA | WORKERS COMP | $322 |
| WC HARTFORD | WORKERS COMP | $322 |
| WC RURAL MUTUAL | WORKERS COMP | $322 |
| WC BERKLEY ADMIN | WORKERS COMP | $322 |
| WC ZURICH | WORKERS COMP | $322 |
| WC TRAVELERS | WORKERS COMP | $322 |
| WC MAC RISK MANAGEMENT | WORKERS COMP | $322 |
| WC QUALCARE | WORKERS COMP | $322 |
| WC SAIF OREGON | WORKERS COMP | $322 |
| WC AMERICAN CLAIMS MGMT | WORKERS COMP | $322 |
| WC ACUITY | WORKERS COMP | $322 |
| GENEX WC | WORKERS COMP | $322 |
| WC CALIFORNIA STATE COMP INS | WORKERS COMP | $322 |
| WC AIMS | WORKERS COMP | $322 |
| WC ALASKA NATIONAL INS | WORKERS COMP | $322 |
| WC AM TRUST N AMERICA | WORKERS COMP | $322 |
| WC ADVANTAGE | WORKERS COMP | $322 |
| WC ENCORE HEALTH NETWORK | WORKERS COMP | $322 |
| WC SECURA | WORKERS COMP | $322 |
| EAST GREENBUSH CENTRAL SCHOOL DISTRICT | WORKERS COMP | $322 |
| WC YANKEE TRAILS | WORKERS COMP | $322 |
| WC KEMBERTON | WORKERS COMP | $322 |
| WC TROY NY | WORKERS COMP | $322 |
| WC PARADIGM | WORKERS COMP | $322 |
| WC MICHIGAN MILLERS MUTUAL | WORKERS COMP | $322 |
| WC BUNCH & ASSOCIATES | WORKERS COMP | $322 |
| WC ACCIDENT FUND | WORKERS COMP | $322 |
| WC ACE | WORKERS COMP | $322 |
| WC AEGIS | WORKERS COMP | $322 |
| WC AIG | WORKERS COMP | $322 |
| WC OHIO BUREAU | WORKERS COMP | $322 |
| WC PEERLESS | WORKERS COMP | $322 |
| WC DONEGAL INSURANCE GROUP | WORKERS COMP | $322 |
| WC FORD MOTOR | WORKERS COMP | $322 |
| RX SAIF OPDP WC | WORKERS COMP | $322 |
| WC GREAT WEST CASUALTY | WORKERS COMP | $322 |
| WC COMP ONE ADMIN C/O MANAGEABILITY | WORKERS COMP | $322 |
| HEALTHSMART WORKERS COMP | WORKERS COMP | $322 |
| WC TRISTAR | WORKERS COMP | $322 |
| WC KEY INS & BENEFIT SOLUTIONS | WORKERS COMP | $322 |
| WC MERCY WORKCARE | WORKERS COMP | $322 |
| WC ICW GROUP | WORKERS COMP | $322 |
| WC INTERCARE INSURANCE | WORKERS COMP | $322 |
| WC AETNA | WORKERS COMP | $322 |
| WC INTERMOUNTAIN | WORKERS COMP | $322 |
| WC VELOCITY | WORKERS COMP | $322 |
| WC O'HARA CORP | WORKERS COMP | $322 |
| WC QUIKTRIP | WORKERS COMP | $322 |
| WC RENY COMPANY | WORKERS COMP | $322 |
| WC FRESNO UNIFIED EMP | WORKERS COMP | $322 |
| WC HAB | WORKERS COMP | $322 |
| WC CITY OF SIOUX CITY | WORKERS COMP | $322 |
| WC CLAIMS MGMT INC | WORKERS COMP | $322 |
| WC CALIFORNIA STATE INS FUND | WORKERS COMP | $322 |
| WC YORK RISK | WORKERS COMP | $322 |
| WC REV CLAIMS | WORKERS COMP | $322 |
| WC GUARANTEE INSURANCE | WORKERS COMP | $322 |
| WC ERIE | WORKERS COMP | $322 |
| WC CCMSI | WORKERS COMP | $322 |
| WC CT HEALTHCARE TRUST | WORKERS COMP | $322 |
| WC HASTINGS | WORKERS COMP | $322 |
| WC LIBERTY MUTUAL | WORKERS COMP | $322 |
| WC MICHIGAN | WORKERS COMP | $322 |
| WC MDIA | WORKERS COMP | $322 |
| WC GENEX CARE FOR OHIO | WORKERS COMP | $322 |
| WC HEALTH MANAGEMENT | WORKERS COMP | $322 |
| WC HIRERIGHT | WORKERS COMP | $322 |
| WC COMPONE ADMIN | WORKERS COMP | $322 |
| WC NATIONWIDE | WORKERS COMP | $322 |
| WC NOTRE DAME | WORKERS COMP | $322 |
| WC SRS | WORKERS COMP | $322 |
| WC FED EX | WORKERS COMP | $322 |
| WC ESIS | WORKERS COMP | $322 |
| WC OCC HEALTH ALLEN | WORKERS COMP | $322 |
| WC WEST BEND | WORKERS COMP | $322 |
| WC FEDERATED | WORKERS COMP | $322 |
| WC CAPITOL AREA HEALTH CONSORTIUM | WORKERS COMP | $322 |
| WC FINLEY OCCUPATIONAL HEALTH | WORKERS COMP | $322 |
| WC GALLAGHER BASSETT | WORKERS COMP | $322 |
| WC MRA | WORKERS COMP | $322 |
| WC PROCURA MANAGEMENT | WORKERS COMP | $322 |
| WC SMILE LODGE | WORKERS COMP | $322 |
| WC PARADIGM | WORKERS COMP | $322 |
| WC MICHIGAN MILLERS MUTUAL | WORKERS COMP | $322 |
| WC GREAT WEST CASUALTY | WORKERS COMP | $322 |
| RX HEATLHCOMP | WORKERS COMP | $322 |
| WC WINNEBAGO INDUSTRIES | WORKERS COMP | $322 |
| WC ENCORE HEALTH NETWORK | WORKERS COMP | $322 |
| WC VELOCITY | WORKERS COMP | $322 |
| WC QUIKTRIP | WORKERS COMP | $322 |
| WC RENY COMPANY | WORKERS COMP | $322 |
| WC ESIS | WORKERS COMP | $322 |
| WC UNITED HEARTLAND | WORKERS COMP | $322 |
| WC OCC HEALTH ALLEN | WORKERS COMP | $322 |
| WC FIRST AGENCY/OCCUNET | WORKERS COMP | $322 |
| WC TYSON | WORKERS COMP | $322 |
| WC MERCY WORKCARE | WORKERS COMP | $322 |
| WC O'HARA CORP | WORKERS COMP | $322 |
| WC CAPITOL AREA HEALTH CONSORTIUM | WORKERS COMP | $322 |
| WC WEST BEND | WORKERS COMP | $322 |
| WC FINLEY OCCUPATIONAL HEALTH | WORKERS COMP | $322 |
| WC CT HEALTHCARE TRUST | WORKERS COMP | $322 |
| WC LIBERTY MUTUAL | WORKERS COMP | $322 |
| WC CCMSI | WORKERS COMP | $322 |
| WC FEDERATED | WORKERS COMP | $322 |
| WC GALLAGHER BASSETT | WORKERS COMP | $322 |
| WC HASTINGS | WORKERS COMP | $322 |
| WC ERIE | WORKERS COMP | $322 |
| WC PMA | WORKERS COMP | $322 |
| WC WEST BEND MUTUAL/ARGENT | WORKERS COMP | $322 |
| WC TRAVELERS | WORKERS COMP | $322 |
| WC PEERLESS | WORKERS COMP | $322 |
| WC FORD MOTOR | WORKERS COMP | $322 |
| WC ASU RISK MGT | WORKERS COMP | $322 |
| RX SAIF OPDP WC | WORKERS COMP | $322 |
| WC SEDGWICK | WORKERS COMP | $322 |
| WC MEMIC | WORKERS COMP | $322 |
| WC SOCIETY | WORKERS COMP | $322 |
| WC ONE CALL MEDICAL | WORKERS COMP | $322 |
| WC OHIO BUREAU | WORKERS COMP | $322 |
| WC EMC INSURANCE COMPANY | WORKERS COMP | $322 |
| WC US DEPT OF LABOR | WORKERS COMP | $322 |
| WC MRA | WORKERS COMP | $322 |
| WC CIRMA | WORKERS COMP | $322 |
| WC ZENITH | WORKERS COMP | $322 |
| WC FCCI | WORKERS COMP | $322 |
| WC ENABLECOMP | WORKERS COMP | $322 |
| WC MEIJERS | WORKERS COMP | $322 |
| WC SRS | WORKERS COMP | $322 |
| WC MEADOWBROOK CLAIM | WORKERS COMP | $322 |
| WC WALMART | WORKERS COMP | $322 |
| WC TRIAD GROUP | WORKERS COMP | $322 |
| WC TROY NY | WORKERS COMP | $322 |
| WC TACONIC FARMS | WORKERS COMP | $322 |
| WC JOHNS EASTERN | WORKERS COMP | $322 |
| WC UNIFIED HEALTH SERVICES | WORKERS COMP | $322 |
| WC SENTRY | WORKERS COMP | $322 |
| WC RURAL MUTUAL | WORKERS COMP | $322 |
| WC BERKLEY ADMIN | WORKERS COMP | $322 |
| WC ZURICH | WORKERS COMP | $322 |
| WC MAC RISK MANAGEMENT | WORKERS COMP | $322 |
| WC AIG | WORKERS COMP | $322 |
| WC YORK RISK | WORKERS COMP | $322 |
| WC REV CLAIMS | WORKERS COMP | $322 |
| WC NOVANET | WORKERS COMP | $322 |
| WC BUNCH & ASSOCIATES | WORKERS COMP | $322 |
| WC EMPLOYEE MUTUAL | WORKERS COMP | $322 |
| WC FEDERAL BLACK LUNG | WORKERS COMP | $322 |
| WC MITCHELL FRANKENMUTH | WORKERS COMP | $322 |
| WC MICHIGAN | WORKERS COMP | $322 |
| WC ACS FEDERAL EMPLOYEES | WORKERS COMP | $322 |
| WC MDIA | WORKERS COMP | $322 |
| WC NOTRE DAME | WORKERS COMP | $322 |
| EAST GREENBUSH CENTRAL SCHOOL DISTRICT | WORKERS COMP | $322 |
| WC ADVANTAGE | WORKERS COMP | $322 |
| WC KEMBERTON | WORKERS COMP | $322 |
| WC YANKEE TRAILS | WORKERS COMP | $322 |
| WC CNA | WORKERS COMP | $322 |
| WC CHARTIS | WORKERS COMP | $322 |
| WC GUARD INSURANCE COMPANY | WORKERS COMP | $322 |
| WC GUARANTEE INSURANCE | WORKERS COMP | $322 |
| WC AMTRUST | WORKERS COMP | $322 |
| WC BROADSPIRE | WORKERS COMP | $322 |
| WC NORTH AMERICAN RISHCES | WORKERS COMP | $322 |
| WC AMERISURE | WORKERS COMP | $322 |
| WC AETNA | WORKERS COMP | $322 |
| WC ACE | WORKERS COMP | $322 |
| WC AEGIS | WORKERS COMP | $322 |
| WC ALLIED | WORKERS COMP | $322 |
| WC ACCIDENT FUND | WORKERS COMP | $322 |
| WC CALIFORNIA STATE INS FUND | WORKERS COMP | $322 |
| WC CALIFORNIA STATE COMP INS | WORKERS COMP | $322 |
| WC AM TRUST N AMERICA | WORKERS COMP | $322 |
| WC AIMS | WORKERS COMP | $322 |
| WC ALASKA NATIONAL INS | WORKERS COMP | $322 |
| WC HORIZON | WORKERS COMP | $322 |
| NEW YORK STATE INSURANCE FUND | WORKERS COMP | $322 |
| WC INTERCARE INSURANCE | WORKERS COMP | $322 |
| WC KEY INS & BENEFIT SOLUTIONS | WORKERS COMP | $322 |
| WC ICW GROUP | WORKERS COMP | $322 |
| WC FRESNO UNIFIED EMP | WORKERS COMP | $322 |
| WC HAB | WORKERS COMP | $322 |
| WC CITY OF SIOUX CITY | WORKERS COMP | $322 |
| WC SAIF OREGON | WORKERS COMP | $322 |
| WC ALIGN NETWORK | WORKERS COMP | $322 |
| WC IDAHO STATE INS FUND | WORKERS COMP | $322 |
| WC QUALCARE | WORKERS COMP | $322 |
| WC INTERMOUNTAIN | WORKERS COMP | $322 |
| NJM INSURANCE GROUP | WORKERS COMP | $322 |
| WC FED EX | WORKERS COMP | $322 |
| WC BENETECH | WORKERS COMP | $322 |
| WC COMPONE ADMIN | WORKERS COMP | $322 |
| WC CITY OF ALBANY | WORKERS COMP | $322 |
| WC CLAIMS MGMT INC | WORKERS COMP | $322 |
| WC TRISTAR | WORKERS COMP | $322 |
| RX RESTAT | WORKERS COMP | $322 |
| ANDRIE INC | WORKERS COMP | $322 |
| WC MASSACHUSETTS | WORKERS COMP | $322 |
| WC RISICO | WORKERS COMP | $322 |
| JAG SOURCE | WORKERS COMP | $322 |
| WC TACONIC (MRO) | WORKERS COMP | $322 |
| WC NORTHEAST HEALTH | WORKERS COMP | $322 |
| WC PRICE CHOPPER | WORKERS COMP | $322 |
| WC SHEAKLEY UNICOMP | WORKERS COMP | $322 |
| WC NEW YORK | WORKERS COMP | $322 |
| WC NEW YORK SPECIAL FUNDS | WORKERS COMP | $322 |
| WC HIRERIGHT | WORKERS COMP | $322 |
| WC GENERIC | WORKERS COMP | $322 |
| WC NATIONWIDE | WORKERS COMP | $322 |
| WC EVOLUTIONS | WORKERS COMP | $322 |
| WC HARTFORD | WORKERS COMP | $322 |
| WC MEDICAL ADMINISTRATORS | WORKERS COMP | $322 |
| WC NCA COMP | WORKERS COMP | $322 |
| WC GENEX CARE FOR OHIO | WORKERS COMP | $322 |
| WC HEALTH MANAGEMENT | WORKERS COMP | $322 |
| WC PROCURA MANAGEMENT | WORKERS COMP | $322 |
| WC GENERAL MOTORS | WORKERS COMP | $322 |
| HEALTHSMART WORKERS COMP | WORKERS COMP | $322 |
| RX WORKER'S COMP | WORKERS COMP | $322 |
| WC CHUBB | WORKERS COMP | $322 |
| WC AMERICAN CLAIMS MGMT | WORKERS COMP | $322 |
| WC ACUITY | WORKERS COMP | $322 |
| GENEX WC | WORKERS COMP | $322 |
| WC DONEGAL INSURANCE GROUP | WORKERS COMP | $322 |
| WC COMP ONE ADMIN C/O MANAGEABILITY | WORKERS COMP | $322 |
| WC SECURA | WORKERS COMP | $322 |
| CONNECTICARE | FIRST HEALTH | $346.66 |
| EMBLEM HEALTH | FIRST HEALTH | $346.66 |
| FIRST HEALTH | FIRST HEALTH | $346.66 |
| PENFIELD CARE | INTERNATIONAL | $354.34 |
| NATIONAL HEALTHCARE SOLUTIONS | INTERNATIONAL | $354.34 |
| DESJARDINS FINANCIAL SECURITY LIFE ASSURANCE | INTERNATIONAL | $354.34 |
| OLYMPUS MANAGED HEALTH CARE | INTERNATIONAL | $354.34 |
| AXA ASSISTANCE US | INTERNATIONAL | $354.34 |
| WW CONCIERGE HEALTHCARE SERVICE | INTERNATIONAL | $354.34 |
| GLOBAL HEALTH CLAIM SERVICES | INTERNATIONAL | $354.34 |
| SANUS HEALTHCARE | SANUS HEALTH MAINTENANCE ADMINISTRATORS | $354.34 |
| AXIS SERVICES | INTERNATIONAL | $354.34 |
| CMN GLOBAL | INTERNATIONAL | $354.34 |
| GLOBAL MEDICAL MANAGEMENT | INTERNATIONAL | $354.34 |
| GUARDIAN | INTERNATIONAL | $354.34 |
| ALLIANZ GLOBAL ASSISTANCE | INTERNATIONAL | $354.34 |
| MORGAN WHITE ADMINISTRATORS | MORGAN WHITE ADMINISTRATORS | $354.34 |
| GLOBAL BENEFITS GROUP | GLOBAL BENEFITS PLAN | $354.34 |
| QUALITY HEALTH MANAGEMENT | INTERNATIONAL | $354.34 |
| AUTO LIABILILTY PRAXIS | AUTO PRAXIS HEALTH NETWORK | $355.99 |
| WC PRAXIS HEALTH NETWORK | WC PRAXIS HEALTH NETWORK | $355.99 |
| SUNMED INTERNATIONAL | SUNMED INTERNATIONAL | $366.15 |
| INTERNATIONAL GENERIC | STAR HEALTHCARE NETWORK PPO | $383.86 |
| MULTIPLAN | DIMENSION HEALTH MULTIPLAN | $393.22 |
| MULTIPLAN | BEECH STREET | $393.22 |
| MULTIPLAN | BEECH STREET | $393.22 |
| MULTIPLAN | DIMENSION HEALTH MULTIPLAN | $393.22 |
| MULTIPLAN | BEECH STREET | $393.22 |
| MULTIPLAN | DIMENSION HEALTH MULTIPLAN | $393.22 |
| PHCS | PHCS | $413.39 |
| UNICARE | PHCS | $413.39 |
| HEARTLAND HOSPICE | HEARTLAND HOSPICE | $413.92 |
| COMMUNITY CARE PLAN | CCP BROWARD HEART | $413.92 |
| GENERAL ELECTRIC | GENERAL ELECTRIC | $413.92 |
| COMMUNITY CARE PLAN MEDICAID ADVANTAGE | COMMUNITY CARE PLAN MEDICAID | $413.92 |
| SUNBELT INTERNATIONAL | SUNBELT INTERNATIONAL | $413.92 |
| WELLCARE MEDICAID | SUNSHINE STATE HEALTH PLAN MEDICAID | $413.92 |
| SUNSHINE STATE HEALTH PLAN | SUNSHINE STATE HEALTH PLAN MEDICAID | $413.92 |
| HUMANA MEDICAID | HUMANA MEDICAID HMO | $413.92 |
| HOSPICE VITAS | VITAS HEALTHCARE HOSPICE | $413.92 |
| GENERAL ELECTRIC | GENERAL ELECTRIC | $413.92 |
| SUNBELT INTERNATIONAL | SUNBELT INTERNATIONAL | $413.92 |
| HEARTLAND HOSPICE | HEARTLAND HOSPICE | $413.92 |
| HOSPICE VITAS | VITAS HEALTHCARE HOSPICE | $413.92 |
| COMMUNITY CARE PLAN | CCP BROWARD HEART | $413.92 |
| COMMUNITY CARE PLAN MEDICAID ADVANTAGE | COMMUNITY CARE PLAN MEDICAID | $413.92 |
| HUMANA MEDICAID | HUMANA MEDICAID HMO | $413.92 |
| SUNSHINE STATE HEALTH PLAN | SUNSHINE STATE HEALTH PLAN MEDICAID | $413.92 |
| WELLCARE MEDICAID | SUNSHINE STATE HEALTH PLAN MEDICAID | $413.92 |
| COMMUNITY CARE PLAN | CCP BROWARD HEART | $413.92 |
| SUNBELT INTERNATIONAL | SUNBELT INTERNATIONAL | $413.92 |
| HEARTLAND HOSPICE | HEARTLAND HOSPICE | $413.92 |
| HOSPICE VITAS | VITAS HEALTHCARE HOSPICE | $413.92 |
| GENERAL ELECTRIC | GENERAL ELECTRIC | $413.92 |
| HUMANA MEDICAID | HUMANA MEDICAID HMO | $413.92 |
| SUNSHINE STATE HEALTH PLAN | SUNSHINE STATE HEALTH PLAN MEDICAID | $413.92 |
| COMMUNITY CARE PLAN MEDICAID ADVANTAGE | COMMUNITY CARE PLAN MEDICAID | $413.92 |
| WELLCARE MEDICAID | SUNSHINE STATE HEALTH PLAN MEDICAID | $413.92 |
| MULTIPLAN | BEECH STREET | $459.20 |
| GLOBAL BENEFITS GROUP | INTERNATIONAL | $524.80 |
| SELECTCARE WORLDWIDE | INTERNATIONAL | $524.80 |
| AXIS SERVICES | INTERNATIONAL | $524.80 |
| SUNMED INTERNATIONAL | INTERNATIONAL | $524.80 |
| ALLIANZ GLOBAL ASSISTANCE | INTERNATIONAL | $524.80 |
| SANUS HEALTHCARE | INTERNATIONAL | $524.80 |
| STAR HEALTHCARE NETWORK | INTERNATIONAL | $524.80 |
| DESJARDINS FINANCIAL SECURITY LIFE ASSURANCE | INTERNATIONAL | $524.80 |
| MORGAN WHITE ADMINISTRATORS | INTERNATIONAL | $524.80 |
| NATIONAL HEALTHCARE SOLUTIONS | INTERNATIONAL | $524.80 |
| GLOBAL HEALTH CLAIM SERVICES | INTERNATIONAL | $524.80 |
| PENFIELD CARE | INTERNATIONAL | $524.80 |
| AXA ASSISTANCE US | INTERNATIONAL | $524.80 |
| OLYMPUS MANAGED HEALTH CARE | INTERNATIONAL | $524.80 |
| WW CONCIERGE HEALTHCARE SERVICE | INTERNATIONAL | $524.80 |
| MULTIPLAN | DIMENSION HEALTH MULTIPLAN | $561.03 |
| MULTIPLAN | BEECH STREET | $561.03 |
| COMMUNITY CARE PLAN MEDICAID ADVANTAGE | COMMUNITY CARE PLAN MEDICAID | $590.56 |
| WELLCARE MEDICAID | SUNSHINE STATE HEALTH PLAN MEDICAID | $590.56 |
| HUMANA MEDICAID | HUMANA MEDICAID HMO | $590.56 |
| GENERAL ELECTRIC | GENERAL ELECTRIC | $590.56 |
| HOSPICE VITAS | VITAS HEALTHCARE HOSPICE | $590.56 |
| SUNSHINE STATE HEALTH PLAN | SUNSHINE STATE HEALTH PLAN MEDICAID | $590.56 |
| COMMUNITY CARE PLAN | CCP BROWARD HEART | $590.56 |
| SUNBELT INTERNATIONAL | SUNBELT INTERNATIONAL | $590.56 |
| HEARTLAND HOSPICE | HEARTLAND HOSPICE | $590.56 |
| AETNA MEDICARE ADVANTAGE | AETNA MEDICARE ADVANTAGE | $609.46 |
| AETNA MEDICARE ADVANTAGE | AETNA MEDICARE ADVANTAGE | $609.46 |
| TRUSTBRIDGE | TRUSTBRIDGE HOSPICE | $609.46 |
| TRUSTBRIDGE | TRUSTBRIDGE HOSPICE | $609.46 |
| UNITED HEALTHCARE MEDICARE | UNITED HEALTHCARE MEDICARE ADVANTAGE | $609.46 |
| UNITED HEALTHCARE MEDICARE | UNITED HEALTHCARE MEDICARE ADVANTAGE | $609.46 |
| UNITED HEALTHCARE MEDICARE | UNITED HEALTHCARE MEDICARE ADVANTAGE | $609.46 |
| PREFERRED CARE PARTNERS | PREFERRED CARE PARTNERS MEDICARE ADV HMO | $609.46 |
| PREFERRED CARE PARTNERS | PREFERRED CARE PARTNERS MEDICARE ADV HMO | $609.46 |
| PREFERRED CARE PARTNERS | PREFERRED CARE PARTNERS MEDICARE ADV HMO | $609.46 |
| TRUSTBRIDGE | TRUSTBRIDGE HOSPICE | $609.46 |
| TRUSTBRIDGE | TRUSTBRIDGE HOSPICE | $609.46 |
| UNITED HEALTHCARE MEDICARE | UNITED HEALTHCARE MEDICARE ADVANTAGE | $609.46 |
| UNITED HEALTHCARE MEDICARE | UNITED HEALTHCARE MEDICARE ADVANTAGE | $609.46 |
| UNITED HEALTHCARE MEDICARE | UNITED HEALTHCARE MEDICARE ADVANTAGE | $609.46 |
| AETNA MEDICARE ADVANTAGE | AETNA MEDICARE ADVANTAGE | $609.46 |
| AETNA MEDICARE ADVANTAGE | AETNA MEDICARE ADVANTAGE | $609.46 |
| PREFERRED CARE PARTNERS | PREFERRED CARE PARTNERS MEDICARE ADV HMO | $609.46 |
| PREFERRED CARE PARTNERS | PREFERRED CARE PARTNERS MEDICARE ADV HMO | $609.46 |
| PREFERRED CARE PARTNERS | PREFERRED CARE PARTNERS MEDICARE ADV HMO | $609.46 |
| TRUSTBRIDGE | TRUSTBRIDGE HOSPICE | $609.46 |
| TRUSTBRIDGE | TRUSTBRIDGE HOSPICE | $609.46 |
| UNITED HEALTHCARE MEDICARE | UNITED HEALTHCARE MEDICARE ADVANTAGE | $609.46 |
| UNITED HEALTHCARE MEDICARE | UNITED HEALTHCARE MEDICARE ADVANTAGE | $609.46 |
| UNITED HEALTHCARE MEDICARE | UNITED HEALTHCARE MEDICARE ADVANTAGE | $609.46 |
| AETNA MEDICARE ADVANTAGE | AETNA MEDICARE ADVANTAGE | $609.46 |
| AETNA MEDICARE ADVANTAGE | AETNA MEDICARE ADVANTAGE | $609.46 |
| PREFERRED CARE PARTNERS | PREFERRED CARE PARTNERS MEDICARE ADV HMO | $609.46 |
| PREFERRED CARE PARTNERS | PREFERRED CARE PARTNERS MEDICARE ADV HMO | $609.46 |
| PREFERRED CARE PARTNERS | PREFERRED CARE PARTNERS MEDICARE ADV HMO | $609.46 |
| PREFERRED CARE PARTNERS | PREFERRED CARE PARTNERS MEDICARE ADV HMO | $609.46 |
| PREFERRED CARE PARTNERS | PREFERRED CARE PARTNERS MEDICARE ADV HMO | $609.46 |
| PREFERRED CARE PARTNERS | PREFERRED CARE PARTNERS MEDICARE ADV HMO | $609.46 |
| AETNA MEDICARE ADVANTAGE | AETNA MEDICARE ADVANTAGE | $609.46 |
| AETNA MEDICARE ADVANTAGE | AETNA MEDICARE ADVANTAGE | $609.46 |
| UNITED HEALTHCARE MEDICARE | UNITED HEALTHCARE MEDICARE ADVANTAGE | $609.46 |
| UNITED HEALTHCARE MEDICARE | UNITED HEALTHCARE MEDICARE ADVANTAGE | $609.46 |
| UNITED HEALTHCARE MEDICARE | UNITED HEALTHCARE MEDICARE ADVANTAGE | $609.46 |
| TRUSTBRIDGE | TRUSTBRIDGE HOSPICE | $609.46 |
| TRUSTBRIDGE | TRUSTBRIDGE HOSPICE | $609.46 |
| TRUSTBRIDGE | TRUSTBRIDGE HOSPICE | $609.46 |
| TRUSTBRIDGE | TRUSTBRIDGE HOSPICE | $609.46 |
| AETNA MEDICARE ADVANTAGE | AETNA MEDICARE ADVANTAGE | $609.46 |
| UNITED HEALTHCARE MEDICARE | UNITED HEALTHCARE MEDICARE ADVANTAGE | $609.46 |
| UNITED HEALTHCARE MEDICARE | UNITED HEALTHCARE MEDICARE ADVANTAGE | $609.46 |
| PREFERRED CARE PARTNERS | PREFERRED CARE PARTNERS MEDICARE ADV HMO | $609.46 |
| PREFERRED CARE PARTNERS | PREFERRED CARE PARTNERS MEDICARE ADV HMO | $609.46 |
| AETNA MEDICARE ADVANTAGE | AETNA MEDICARE ADVANTAGE | $609.46 |
| SIMPLY HEALTHCARE MEDICARE ADVANTAGE | SIMPLY HEALTHCARE MEDICARE ADVANTAGE | $621.65 |
| SIMPLY HEALTHCARE MEDICARE ADVANTAGE | SIMPLY HEALTHCARE MEDICARE ADVANTAGE | $621.65 |
| SIMPLY HEALTHCARE MEDICARE ADVANTAGE | SIMPLY HEALTHCARE MEDICARE ADVANTAGE | $621.65 |
| SIMPLY HEALTHCARE MEDICARE ADVANTAGE | SIMPLY HEALTHCARE MEDICARE ADVANTAGE | $621.65 |
| SIMPLY HEALTHCARE MEDICARE ADVANTAGE | SIMPLY HEALTHCARE MEDICARE ADVANTAGE | $621.65 |
| SIMPLY HEALTHCARE MEDICARE ADVANTAGE | SIMPLY HEALTHCARE MEDICARE ADVANTAGE | $621.65 |
| SIMPLY HEALTHCARE MEDICARE ADVANTAGE | SIMPLY HEALTHCARE MEDICARE ADVANTAGE | $621.65 |
| SIMPLY HEALTHCARE MEDICARE ADVANTAGE | SIMPLY HEALTHCARE MEDICARE ADVANTAGE | $621.65 |
| SIMPLY HEALTHCARE MEDICARE ADVANTAGE | SIMPLY HEALTHCARE MEDICARE ADVANTAGE | $621.65 |
| SIMPLY HEALTHCARE MEDICARE ADVANTAGE | SIMPLY HEALTHCARE MEDICARE ADVANTAGE | $621.65 |
| SIMPLY HEALTHCARE MEDICARE ADVANTAGE | SIMPLY HEALTHCARE MEDICARE ADVANTAGE | $621.65 |
| SIMPLY HEALTHCARE MEDICARE ADVANTAGE | SIMPLY HEALTHCARE MEDICARE ADVANTAGE | $621.65 |
| SIMPLY HEALTHCARE MEDICARE ADVANTAGE | SIMPLY HEALTHCARE MEDICARE ADVANTAGE | $621.65 |
| SIMPLY HEALTHCARE MEDICARE ADVANTAGE | SIMPLY HEALTHCARE MEDICARE ADVANTAGE | $621.65 |
| RYAN WHITE FLORIDA MSSRP | POSITIVE HEALTH PARTNERS MEDICARE ADV | $621.90 |
| RYAN WHITE FLORIDA MSSRP | POSITIVE HEALTH PARTNERS MEDICARE ADV | $621.90 |
| FREEDOM HEALTH MEDICARE ADVANTAGE | FREEDOM HEALTH MEDICARE ADVANTAGE | $621.90 |
| OSCAR MEDICARE ADVANTAGE | OSCAR MEDICARE ADVANTAGE | $621.90 |
| OSCAR MEDICARE ADVANTAGE | OSCAR MEDICARE ADVANTAGE | $621.90 |
| POSITIVE HEALTHCARE PARTNERS MEDICARE | POSITIVE HEALTH PARTNERS MEDICARE ADV | $621.90 |
| POSITIVE HEALTHCARE PARTNERS MEDICARE | POSITIVE HEALTH PARTNERS MEDICARE ADV | $621.90 |
| CATHOLIC HOSPICE | CATHOLIC HOSPICE | $621.90 |
| CATHOLIC HOSPICE | CATHOLIC HOSPICE | $621.90 |
| VITAS HEALTHCARE CORP | VITAS HEALTHCARE | $621.90 |
| VITAS HEALTHCARE CORP | VITAS HEALTHCARE | $621.90 |
| COVENTRY MEDICARE ADVANTAGE | COVENTRY MEDICARE ADVANTAGE | $621.90 |
| COVENTRY MEDICARE ADVANTAGE | COVENTRY MEDICARE ADVANTAGE | $621.90 |
| FREEDOM HEALTH MEDICARE ADVANTAGE | FREEDOM HEALTH MEDICARE ADVANTAGE | $621.90 |
| FREEDOM HEALTH MEDICARE ADVANTAGE | FREEDOM HEALTH MEDICARE ADVANTAGE | $621.90 |
| BLUE CROSS - FL MEDICARE ADVANTAGE | BCBS MEDICARE ADVANTAGE | $621.90 |
| BLUE CROSS - FL MEDICARE ADVANTAGE | BCBS MEDICARE ADVANTAGE | $621.90 |
| BLUE CROSS - FL MEDICARE ADVANTAGE | BCBS MEDICARE ADVANTAGE | $621.90 |
| CATHOLIC HOSPICE | CATHOLIC HOSPICE | $621.90 |
| CATHOLIC HOSPICE | CATHOLIC HOSPICE | $621.90 |
| VITAS HEALTHCARE CORP | VITAS HEALTHCARE | $621.90 |
| VITAS HEALTHCARE CORP | VITAS HEALTHCARE | $621.90 |
| POSITIVE HEALTHCARE PARTNERS MEDICARE | POSITIVE HEALTH PARTNERS MEDICARE ADV | $621.90 |
| RYAN WHITE FLORIDA MSSRP | POSITIVE HEALTH PARTNERS MEDICARE ADV | $621.90 |
| RYAN WHITE FLORIDA MSSRP | POSITIVE HEALTH PARTNERS MEDICARE ADV | $621.90 |
| POSITIVE HEALTHCARE PARTNERS MEDICARE | POSITIVE HEALTH PARTNERS MEDICARE ADV | $621.90 |
| BLUE CROSS - FL MEDICARE ADVANTAGE | BCBS MEDICARE ADVANTAGE | $621.90 |
| FREEDOM HEALTH MEDICARE ADVANTAGE | FREEDOM HEALTH MEDICARE ADVANTAGE | $621.90 |
| FREEDOM HEALTH MEDICARE ADVANTAGE | FREEDOM HEALTH MEDICARE ADVANTAGE | $621.90 |
| BLUE CROSS - FL MEDICARE ADVANTAGE | BCBS MEDICARE ADVANTAGE | $621.90 |
| BLUE CROSS - FL MEDICARE ADVANTAGE | BCBS MEDICARE ADVANTAGE | $621.90 |
| OSCAR MEDICARE ADVANTAGE | OSCAR MEDICARE ADVANTAGE | $621.90 |
| OSCAR MEDICARE ADVANTAGE | OSCAR MEDICARE ADVANTAGE | $621.90 |
| FREEDOM HEALTH MEDICARE ADVANTAGE | FREEDOM HEALTH MEDICARE ADVANTAGE | $621.90 |
| COVENTRY MEDICARE ADVANTAGE | COVENTRY MEDICARE ADVANTAGE | $621.90 |
| COVENTRY MEDICARE ADVANTAGE | COVENTRY MEDICARE ADVANTAGE | $621.90 |
| POSITIVE HEALTHCARE PARTNERS MEDICARE | POSITIVE HEALTH PARTNERS MEDICARE ADV | $621.90 |
| RYAN WHITE FLORIDA MSSRP | POSITIVE HEALTH PARTNERS MEDICARE ADV | $621.90 |
| RYAN WHITE FLORIDA MSSRP | POSITIVE HEALTH PARTNERS MEDICARE ADV | $621.90 |
| OSCAR MEDICARE ADVANTAGE | OSCAR MEDICARE ADVANTAGE | $621.90 |
| OSCAR MEDICARE ADVANTAGE | OSCAR MEDICARE ADVANTAGE | $621.90 |
| POSITIVE HEALTHCARE PARTNERS MEDICARE | POSITIVE HEALTH PARTNERS MEDICARE ADV | $621.90 |
| COVENTRY MEDICARE ADVANTAGE | COVENTRY MEDICARE ADVANTAGE | $621.90 |
| COVENTRY MEDICARE ADVANTAGE | COVENTRY MEDICARE ADVANTAGE | $621.90 |
| VITAS HEALTHCARE CORP | VITAS HEALTHCARE | $621.90 |
| VITAS HEALTHCARE CORP | VITAS HEALTHCARE | $621.90 |
| CATHOLIC HOSPICE | CATHOLIC HOSPICE | $621.90 |
| CATHOLIC HOSPICE | CATHOLIC HOSPICE | $621.90 |
| FREEDOM HEALTH MEDICARE ADVANTAGE | FREEDOM HEALTH MEDICARE ADVANTAGE | $621.90 |
| FREEDOM HEALTH MEDICARE ADVANTAGE | FREEDOM HEALTH MEDICARE ADVANTAGE | $621.90 |
| FREEDOM HEALTH MEDICARE ADVANTAGE | FREEDOM HEALTH MEDICARE ADVANTAGE | $621.90 |
| BLUE CROSS - FL MEDICARE ADVANTAGE | BCBS MEDICARE ADVANTAGE | $621.90 |
| BLUE CROSS - FL MEDICARE ADVANTAGE | BCBS MEDICARE ADVANTAGE | $621.90 |
| BLUE CROSS - FL MEDICARE ADVANTAGE | BCBS MEDICARE ADVANTAGE | $621.90 |
| FREEDOM HEALTH MEDICARE ADVANTAGE | FREEDOM HEALTH MEDICARE ADVANTAGE | $621.90 |
| FREEDOM HEALTH MEDICARE ADVANTAGE | FREEDOM HEALTH MEDICARE ADVANTAGE | $621.90 |
| FREEDOM HEALTH MEDICARE ADVANTAGE | FREEDOM HEALTH MEDICARE ADVANTAGE | $621.90 |
| VITAS HEALTHCARE CORP | VITAS HEALTHCARE | $621.90 |
| VITAS HEALTHCARE CORP | VITAS HEALTHCARE | $621.90 |
| CATHOLIC HOSPICE | CATHOLIC HOSPICE | $621.90 |
| CATHOLIC HOSPICE | CATHOLIC HOSPICE | $621.90 |
| OSCAR MEDICARE ADVANTAGE | OSCAR MEDICARE ADVANTAGE | $621.90 |
| OSCAR MEDICARE ADVANTAGE | OSCAR MEDICARE ADVANTAGE | $621.90 |
| POSITIVE HEALTHCARE PARTNERS MEDICARE | POSITIVE HEALTH PARTNERS MEDICARE ADV | $621.90 |
| POSITIVE HEALTHCARE PARTNERS MEDICARE | POSITIVE HEALTH PARTNERS MEDICARE ADV | $621.90 |
| COVENTRY MEDICARE ADVANTAGE | COVENTRY MEDICARE ADVANTAGE | $621.90 |
| COVENTRY MEDICARE ADVANTAGE | COVENTRY MEDICARE ADVANTAGE | $621.90 |
| BLUE CROSS - FL MEDICARE ADVANTAGE | BCBS MEDICARE ADVANTAGE | $621.90 |
| BLUE CROSS - FL MEDICARE ADVANTAGE | BCBS MEDICARE ADVANTAGE | $621.90 |
| BLUE CROSS - FL MEDICARE ADVANTAGE | BCBS MEDICARE ADVANTAGE | $621.90 |
| RYAN WHITE FLORIDA MSSRP | POSITIVE HEALTH PARTNERS MEDICARE ADV | $621.90 |
| RYAN WHITE FLORIDA MSSRP | POSITIVE HEALTH PARTNERS MEDICARE ADV | $621.90 |
| RYAN WHITE FLORIDA MSSRP | POSITIVE HEALTH PARTNERS MEDICARE ADV | $621.90 |
| RYAN WHITE FLORIDA MSSRP | POSITIVE HEALTH PARTNERS MEDICARE ADV | $621.90 |
| VITAS HEALTHCARE CORP | VITAS HEALTHCARE | $621.90 |
| VITAS HEALTHCARE CORP | VITAS HEALTHCARE | $621.90 |
| COVENTRY MEDICARE ADVANTAGE | COVENTRY MEDICARE ADVANTAGE | $621.90 |
| COVENTRY MEDICARE ADVANTAGE | COVENTRY MEDICARE ADVANTAGE | $621.90 |
| CATHOLIC HOSPICE | CATHOLIC HOSPICE | $621.90 |
| CATHOLIC HOSPICE | CATHOLIC HOSPICE | $621.90 |
| FREEDOM HEALTH MEDICARE ADVANTAGE | FREEDOM HEALTH MEDICARE ADVANTAGE | $621.90 |
| FREEDOM HEALTH MEDICARE ADVANTAGE | FREEDOM HEALTH MEDICARE ADVANTAGE | $621.90 |
| BLUE CROSS - FL MEDICARE ADVANTAGE | BCBS MEDICARE ADVANTAGE | $621.90 |
| BLUE CROSS - FL MEDICARE ADVANTAGE | BCBS MEDICARE ADVANTAGE | $621.90 |
| OSCAR MEDICARE ADVANTAGE | OSCAR MEDICARE ADVANTAGE | $621.90 |
| OSCAR MEDICARE ADVANTAGE | OSCAR MEDICARE ADVANTAGE | $621.90 |
| POSITIVE HEALTHCARE PARTNERS MEDICARE | POSITIVE HEALTH PARTNERS MEDICARE ADV | $621.90 |
| POSITIVE HEALTHCARE PARTNERS MEDICARE | POSITIVE HEALTH PARTNERS MEDICARE ADV | $621.90 |
| CAREPLUS HEALTH PLANS | CAREPLUS MEDICARE ADVANTAGE | $623.46 |
| CAREPLUS HEALTH PLANS | CAREPLUS MEDICARE ADVANTAGE | $623.46 |
| CAREPLUS HEALTH PLANS | CAREPLUS MEDICARE ADVANTAGE | $623.46 |
| CAREPLUS HEALTH PLANS | CAREPLUS MEDICARE ADVANTAGE | $623.46 |
| CAREPLUS HEALTH PLANS | CAREPLUS MEDICARE ADVANTAGE | $623.46 |
| CAREPLUS HEALTH PLANS | CAREPLUS MEDICARE ADVANTAGE | $623.46 |
| CAREPLUS HEALTH PLANS | CAREPLUS MEDICARE ADVANTAGE | $623.46 |
| CAREPLUS HEALTH PLANS | CAREPLUS MEDICARE ADVANTAGE | $623.46 |
| CAREPLUS HEALTH PLANS | CAREPLUS MEDICARE ADVANTAGE | $623.46 |
| CAREPLUS HEALTH PLANS | CAREPLUS MEDICARE ADVANTAGE | $623.46 |
| CAREPLUS HEALTH PLANS | CAREPLUS MEDICARE ADVANTAGE | $623.46 |
| CAREPLUS HEALTH PLANS | CAREPLUS MEDICARE ADVANTAGE | $623.46 |
| CAREPLUS HEALTH PLANS | CAREPLUS MEDICARE ADVANTAGE | $623.46 |
| CAREPLUS HEALTH PLANS | CAREPLUS MEDICARE ADVANTAGE | $623.46 |
| CIGNA MEDICARE ADVANTAGE | CIGNA MEDICARE ADVANTAGE | $627.75 |
| CIGNA MEDICARE ADVANTAGE | CIGNA MEDICARE ADVANTAGE | $627.75 |
| CIGNA MEDICARE ADVANTAGE | CIGNA MEDICARE ADVANTAGE | $627.75 |
| CIGNA MEDICARE ADVANTAGE | CIGNA MEDICARE ADVANTAGE | $627.75 |
| CIGNA MEDICARE ADVANTAGE | CIGNA MEDICARE ADVANTAGE | $627.75 |
| CIGNA MEDICARE ADVANTAGE | CIGNA MEDICARE ADVANTAGE | $627.75 |
| CIGNA MEDICARE ADVANTAGE | CIGNA MEDICARE ADVANTAGE | $627.75 |
| CIGNA MEDICARE ADVANTAGE | CIGNA MEDICARE ADVANTAGE | $627.75 |
| CIGNA MEDICARE ADVANTAGE | CIGNA MEDICARE ADVANTAGE | $627.75 |
| CIGNA MEDICARE ADVANTAGE | CIGNA MEDICARE ADVANTAGE | $627.75 |
| CIGNA MEDICARE ADVANTAGE | CIGNA MEDICARE ADVANTAGE | $627.75 |
| CIGNA MEDICARE ADVANTAGE | CIGNA MEDICARE ADVANTAGE | $627.75 |
| CIGNA MEDICARE ADVANTAGE | CIGNA MEDICARE ADVANTAGE | $627.75 |
| CIGNA MEDICARE ADVANTAGE | CIGNA MEDICARE ADVANTAGE | $627.75 |
| TRUSTBRIDGE | TRUSTBRIDGE HOSPICE | $629.18 |
| TRUSTBRIDGE | TRUSTBRIDGE HOSPICE | $629.18 |
| TRUSTBRIDGE | TRUSTBRIDGE HOSPICE | $629.18 |
| TRUSTBRIDGE | TRUSTBRIDGE HOSPICE | $629.18 |
| WC PRAXIS HEALTH NETWORK | WC PRAXIS HEALTH NETWORK | $636.32 |
| AUTO LIABILILTY PRAXIS | AUTO PRAXIS HEALTH NETWORK | $636.32 |
| HEALTHSUN MEDICARE ADVANTAGE | HEALTHSUN MEDICARE ADVANTAGE | $639.94 |
| GOLD KIDNEY MEDICARE | MULTIPLAN MEDICARE ADVANTAGE | $639.94 |
| GOLD KIDNEY MEDICARE | MULTIPLAN MEDICARE ADVANTAGE | $639.94 |
| GOLD KIDNEY MEDICARE | MULTIPLAN MEDICARE ADVANTAGE | $639.94 |
| WELLCARE MEDICARE | WELLCARE MEDICARE ADVANTAGE | $639.94 |
| WELLCARE MEDICARE | WELLCARE MEDICARE ADVANTAGE | $639.94 |
| WELLCARE MEDICARE | WELLCARE MEDICARE ADVANTAGE | $639.94 |
| HEALTHSUN MEDICARE ADVANTAGE | HEALTHSUN MEDICARE ADVANTAGE | $639.94 |
| HEALTHSUN MEDICARE ADVANTAGE | HEALTHSUN MEDICARE ADVANTAGE | $639.94 |
| WELLCARE MEDICARE | WELLCARE MEDICARE ADVANTAGE | $639.94 |
| WELLCARE MEDICARE | WELLCARE MEDICARE ADVANTAGE | $639.94 |
| WELLCARE MEDICARE | WELLCARE MEDICARE ADVANTAGE | $639.94 |
| GOLD KIDNEY MEDICARE | MULTIPLAN MEDICARE ADVANTAGE | $639.94 |
| GOLD KIDNEY MEDICARE | MULTIPLAN MEDICARE ADVANTAGE | $639.94 |
| GOLD KIDNEY MEDICARE | MULTIPLAN MEDICARE ADVANTAGE | $639.94 |
| HEALTHSUN MEDICARE ADVANTAGE | HEALTHSUN MEDICARE ADVANTAGE | $639.94 |
| HEALTHSUN MEDICARE ADVANTAGE | HEALTHSUN MEDICARE ADVANTAGE | $639.94 |
| HEALTHSUN MEDICARE ADVANTAGE | HEALTHSUN MEDICARE ADVANTAGE | $639.94 |
| GOLD KIDNEY MEDICARE | MULTIPLAN MEDICARE ADVANTAGE | $639.94 |
| GOLD KIDNEY MEDICARE | MULTIPLAN MEDICARE ADVANTAGE | $639.94 |
| GOLD KIDNEY MEDICARE | MULTIPLAN MEDICARE ADVANTAGE | $639.94 |
| WELLCARE MEDICARE | WELLCARE MEDICARE ADVANTAGE | $639.94 |
| WELLCARE MEDICARE | WELLCARE MEDICARE ADVANTAGE | $639.94 |
| WELLCARE MEDICARE | WELLCARE MEDICARE ADVANTAGE | $639.94 |
| HEALTHSUN MEDICARE ADVANTAGE | HEALTHSUN MEDICARE ADVANTAGE | $639.94 |
| HEALTHSUN MEDICARE ADVANTAGE | HEALTHSUN MEDICARE ADVANTAGE | $639.94 |
| HEALTHSUN MEDICARE ADVANTAGE | HEALTHSUN MEDICARE ADVANTAGE | $639.94 |
| HEALTHSUN MEDICARE ADVANTAGE | HEALTHSUN MEDICARE ADVANTAGE | $639.94 |
| HEALTHSUN MEDICARE ADVANTAGE | HEALTHSUN MEDICARE ADVANTAGE | $639.94 |
| HEALTHSUN MEDICARE ADVANTAGE | HEALTHSUN MEDICARE ADVANTAGE | $639.94 |
| GOLD KIDNEY MEDICARE | MULTIPLAN MEDICARE ADVANTAGE | $639.94 |
| GOLD KIDNEY MEDICARE | MULTIPLAN MEDICARE ADVANTAGE | $639.94 |
| GOLD KIDNEY MEDICARE | MULTIPLAN MEDICARE ADVANTAGE | $639.94 |
| WELLCARE MEDICARE | WELLCARE MEDICARE ADVANTAGE | $639.94 |
| WELLCARE MEDICARE | WELLCARE MEDICARE ADVANTAGE | $639.94 |
| WELLCARE MEDICARE | WELLCARE MEDICARE ADVANTAGE | $639.94 |
| WELLCARE MEDICARE | WELLCARE MEDICARE ADVANTAGE | $639.94 |
| WELLCARE MEDICARE | WELLCARE MEDICARE ADVANTAGE | $639.94 |
| HEALTHSUN MEDICARE ADVANTAGE | HEALTHSUN MEDICARE ADVANTAGE | $639.94 |
| HEALTHSUN MEDICARE ADVANTAGE | HEALTHSUN MEDICARE ADVANTAGE | $639.94 |
| GOLD KIDNEY MEDICARE | MULTIPLAN MEDICARE ADVANTAGE | $639.94 |
| GOLD KIDNEY MEDICARE | MULTIPLAN MEDICARE ADVANTAGE | $639.94 |
| AVMED HEALTH PLAN | AVMED SELECT NETWORK | $646.75 |
| AVMED HEALTH PLAN | AVMED SELECT NETWORK | $646.75 |
| AVMED HEALTH PLAN | AVMED SELECT NETWORK | $646.75 |
| SOLIS HEALTH PLANS | SOLIS HEALTH PLANS | $653 |
| SOLIS HEALTH PLANS | SOLIS HEALTH PLANS | $653 |
| SOLIS HEALTH PLANS | SOLIS HEALTH PLANS | $653 |
| AVMED MEDICARE | AVMED MEDICARE ADVANTAGE | $653 |
| AVMED MEDICARE | AVMED MEDICARE ADVANTAGE | $653 |
| AVMED MEDICARE | AVMED MEDICARE ADVANTAGE | $653 |
| DEVOTED HEALTH MEDICARE ADVANTAGE | DEVOTED HEALTH MEDICARE ADVANTAGE | $653 |
| DEVOTED HEALTH MEDICARE ADVANTAGE | DEVOTED HEALTH MEDICARE ADVANTAGE | $653 |
| AVMED MEDICARE | AVMED MEDICARE ADVANTAGE | $653 |
| AVMED MEDICARE | AVMED MEDICARE ADVANTAGE | $653 |
| AVMED MEDICARE | AVMED MEDICARE ADVANTAGE | $653 |
| SOLIS HEALTH PLANS | SOLIS HEALTH PLANS | $653 |
| SOLIS HEALTH PLANS | SOLIS HEALTH PLANS | $653 |
| SOLIS HEALTH PLANS | SOLIS HEALTH PLANS | $653 |
| DEVOTED HEALTH MEDICARE ADVANTAGE | DEVOTED HEALTH MEDICARE ADVANTAGE | $653 |
| DEVOTED HEALTH MEDICARE ADVANTAGE | DEVOTED HEALTH MEDICARE ADVANTAGE | $653 |
| DEVOTED HEALTH MEDICARE ADVANTAGE | DEVOTED HEALTH MEDICARE ADVANTAGE | $653 |
| SOLIS HEALTH PLANS | SOLIS HEALTH PLANS | $653 |
| SOLIS HEALTH PLANS | SOLIS HEALTH PLANS | $653 |
| SOLIS HEALTH PLANS | SOLIS HEALTH PLANS | $653 |
| AVMED MEDICARE | AVMED MEDICARE ADVANTAGE | $653 |
| AVMED MEDICARE | AVMED MEDICARE ADVANTAGE | $653 |
| AVMED MEDICARE | AVMED MEDICARE ADVANTAGE | $653 |
| DEVOTED HEALTH MEDICARE ADVANTAGE | DEVOTED HEALTH MEDICARE ADVANTAGE | $653 |
| AVMED MEDICARE | AVMED MEDICARE ADVANTAGE | $653 |
| AVMED MEDICARE | AVMED MEDICARE ADVANTAGE | $653 |
| AVMED MEDICARE | AVMED MEDICARE ADVANTAGE | $653 |
| DEVOTED HEALTH MEDICARE ADVANTAGE | DEVOTED HEALTH MEDICARE ADVANTAGE | $653 |
| DEVOTED HEALTH MEDICARE ADVANTAGE | DEVOTED HEALTH MEDICARE ADVANTAGE | $653 |
| SOLIS HEALTH PLANS | SOLIS HEALTH PLANS | $653 |
| SOLIS HEALTH PLANS | SOLIS HEALTH PLANS | $653 |
| SOLIS HEALTH PLANS | SOLIS HEALTH PLANS | $653 |
| DEVOTED HEALTH MEDICARE ADVANTAGE | DEVOTED HEALTH MEDICARE ADVANTAGE | $653 |
| DEVOTED HEALTH MEDICARE ADVANTAGE | DEVOTED HEALTH MEDICARE ADVANTAGE | $653 |
| AVMED MEDICARE | AVMED MEDICARE ADVANTAGE | $653 |
| AVMED MEDICARE | AVMED MEDICARE ADVANTAGE | $653 |
| SOLIS HEALTH PLANS | SOLIS HEALTH PLANS | $653 |
| SOLIS HEALTH PLANS | SOLIS HEALTH PLANS | $653 |
| MOLINA MEDICAID | MOLINA HEALTHCARE MEDICAID | $776.10 |
| MOLINA MEDICAID | MOLINA HEALTHCARE MEDICAID | $776.10 |
| MOLINA MEDICAID | MOLINA HEALTHCARE MEDICAID | $776.10 |
| MOLINA MARKETPLACE | MOLINA MARKETPLACE HMO | $881.86 |
| MOLINA MARKETPLACE | MOLINA MARKETPLACE HMO | $881.86 |
| MOLINA MARKETPLACE | MOLINA MARKETPLACE HMO | $881.86 |
| MOLINA MARKETPLACE | MOLINA MARKETPLACE HMO | $881.86 |
| MOLINA MARKETPLACE | MOLINA MARKETPLACE HMO | $881.86 |
| MOLINA MARKETPLACE | MOLINA MARKETPLACE HMO | $881.86 |
| MOLINA MARKETPLACE | MOLINA MARKETPLACE HMO | $881.86 |
| MOLINA MARKETPLACE | MOLINA MARKETPLACE HMO | $881.86 |
| MOLINA MARKETPLACE | MOLINA MARKETPLACE HMO | $881.86 |
| MOLINA MARKETPLACE | MOLINA MARKETPLACE HMO | $881.86 |
| AVMED HEALTH PLAN | AVMED SELECT NETWORK | $922.75 |
| BLUE CROSS - FL | TRULI FOR HEALTH | $951.51 |
| BLUE CROSS - FL | TRULI FOR HEALTH | $951.51 |
| BLUE CROSS - FL | TRULI FOR HEALTH | $951.51 |
| BLUE CROSS - FL | TRULI FOR HEALTH | $951.51 |
| BLUE CROSS - FL | TRULI FOR HEALTH | $951.51 |
| BLUE CROSS - FL | TRULI FOR HEALTH | $951.51 |
| BLUE CROSS - FL | TRULI FOR HEALTH | $951.51 |
| BLUE CROSS - FL | TRULI FOR HEALTH | $951.51 |
| BLUE CROSS - FL | TRULI FOR HEALTH | $951.51 |
| BLUE CROSS - FL | TRULI FOR HEALTH | $951.51 |
| FIRST HEALTH | FIRST HEALTH INTERNATIONAL | $1,032.21 |
| FIRST HEALTH | FIRST HEALTH INTERNATIONAL | $1,032.21 |
| FIRST HEALTH | FIRST HEALTH INTERNATIONAL | $1,032.21 |
| OSCAR | OSCAR MARKETPLACE HEALTH PLAN | $1,057.23 |
| OSCAR | OSCAR MARKETPLACE HEALTH PLAN | $1,057.23 |
| OSCAR | OSCAR MARKETPLACE HEALTH PLAN | $1,057.23 |
| OSCAR | OSCAR MARKETPLACE HEALTH PLAN | $1,057.23 |
| OSCAR | OSCAR MARKETPLACE HEALTH PLAN | $1,057.23 |
| OSCAR | OSCAR MARKETPLACE HEALTH PLAN | $1,057.23 |
| OSCAR | OSCAR MARKETPLACE HEALTH PLAN | $1,057.23 |
| OSCAR | OSCAR MARKETPLACE HEALTH PLAN | $1,057.23 |
| OSCAR | OSCAR MARKETPLACE HEALTH PLAN | $1,057.23 |
| OSCAR | OSCAR MARKETPLACE HEALTH PLAN | $1,057.23 |
| HUMANA | HUMANA HMO-PPO | $1,066 |
| HUMANA | HUMANA HMO-PPO | $1,066 |
| HUMANA | HUMANA HMO-PPO | $1,066 |
| HUMANA | HUMANA HMO-PPO | $1,066 |
| HUMANA | HUMANA HMO-PPO | $1,066 |
| HUMANA | HUMANA HMO-PPO | $1,066 |
| HUMANA | HUMANA HMO-PPO | $1,066 |
| HUMANA | HUMANA HMO-PPO | $1,066 |
| HUMANA | HUMANA HMO-PPO | $1,066 |
| HUMANA | HUMANA HMO-PPO | $1,066 |
| AMBETTER | AMBETTER MARKETPLACE | $1,087.10 |
| AMBETTER | AMBETTER MARKETPLACE | $1,087.10 |
| AMBETTER | AMBETTER MARKETPLACE | $1,087.10 |
| AMBETTER | AMBETTER MARKETPLACE | $1,087.10 |
| AMBETTER | AMBETTER MARKETPLACE | $1,087.10 |
| AMBETTER | AMBETTER MARKETPLACE | $1,087.10 |
| AMBETTER | AMBETTER MARKETPLACE | $1,087.10 |
| AMBETTER | AMBETTER MARKETPLACE | $1,087.10 |
| AMBETTER | AMBETTER MARKETPLACE | $1,087.10 |
| AMBETTER | AMBETTER MARKETPLACE | $1,087.10 |
| MOLINA MEDICAID | MOLINA HEALTHCARE MEDICAID | $1,107.30 |
| AVMED HEALTH PLAN | AVMED ENTRUST MARKETPLACE | $1,144.30 |
| AVMED HEALTH PLAN | AVMED ENTRUST MARKETPLACE | $1,144.30 |
| AVMED HEALTH PLAN | AVMED ENTRUST MARKETPLACE | $1,144.30 |
| AVMED HEALTH PLAN | AVMED ENTRUST MARKETPLACE | $1,144.30 |
| AVMED HEALTH PLAN | AVMED ENTRUST MARKETPLACE | $1,144.30 |
| AVMED HEALTH PLAN | AVMED ENTRUST MARKETPLACE | $1,144.30 |
| AVMED HEALTH PLAN | AVMED ENTRUST MARKETPLACE | $1,144.30 |
| AVMED HEALTH PLAN | AVMED ENTRUST MARKETPLACE | $1,144.30 |
| AVMED HEALTH PLAN | AVMED ENTRUST MARKETPLACE | $1,144.30 |
| AVMED HEALTH PLAN | AVMED ENTRUST MARKETPLACE | $1,144.30 |
| AVMED HEALTH PLAN | AVMED HMO | $1,146 |
| AVMED HEALTH PLAN | AVMED HMO | $1,146 |
| AVMED HEALTH PLAN | AVMED HMO | $1,146 |
| AVMED HEALTH PLAN | AVMED HMO | $1,146 |
| AVMED HEALTH PLAN | AVMED HMO | $1,146 |
| AVMED HEALTH PLAN | AVMED HMO | $1,146 |
| AVMED HEALTH PLAN | AVMED HMO | $1,146 |
| AVMED HEALTH PLAN | AVMED HMO | $1,146 |
| AVMED HEALTH PLAN | AVMED HMO | $1,146 |
| AVMED HEALTH PLAN | AVMED HMO | $1,146 |
| CURATIVE | CURATIVE | $1,150.52 |
| CURATIVE | CURATIVE | $1,150.52 |
| CURATIVE | CURATIVE | $1,150.52 |
| CURATIVE | CURATIVE | $1,150.52 |
| CURATIVE | CURATIVE | $1,150.52 |
| CURATIVE | CURATIVE | $1,150.52 |
| CURATIVE | CURATIVE | $1,150.52 |
| CURATIVE | CURATIVE | $1,150.52 |
| CURATIVE | CURATIVE | $1,150.52 |
| CURATIVE | CURATIVE | $1,150.52 |
| BRIDGE HEALTH | BRIDGE HEALTH MEDICAL | $1,293.50 |
| BRIDGE HEALTH | BRIDGE HEALTH MEDICAL | $1,293.50 |
| BRIDGE HEALTH | BRIDGE HEALTH MEDICAL | $1,293.50 |
| AETNA | AETNA GLOBAL BENEFITS | $1,298.67 |
| AETNA | AETNA GLOBAL BENEFITS | $1,298.67 |
| AETNA | AETNA GLOBAL BENEFITS | $1,298.67 |
| CENTIVO | CENTIVO | $1,337.09 |
| CENTIVO | CENTIVO | $1,337.09 |
| CENTIVO | CENTIVO | $1,337.09 |
| CENTIVO | CENTIVO | $1,337.09 |
| CENTIVO | CENTIVO | $1,337.09 |
| CENTIVO | CENTIVO | $1,337.09 |
| CENTIVO | CENTIVO | $1,337.09 |
| CENTIVO | CENTIVO | $1,337.09 |
| CENTIVO | CENTIVO | $1,337.09 |
| CENTIVO | CENTIVO | $1,337.09 |
| COMMUNITY CARE PLAN | MEMORIAL HEALTH SYSTEM | $1,394.91 |
| MEMORIAL INTEGRATED HEALTH | MEMORIAL HEALTH SYSTEM | $1,394.91 |
| COMMUNITY CARE PLAN | MEMORIAL HEALTH SYSTEM | $1,394.91 |
| MEMORIAL INTEGRATED HEALTH | MEMORIAL HEALTH SYSTEM | $1,394.91 |
| COMMUNITY CARE PLAN | MEMORIAL HEALTH SYSTEM | $1,394.91 |
| MEMORIAL INTEGRATED HEALTH | MEMORIAL HEALTH SYSTEM | $1,394.91 |
| AETNA | AETNA MARKETPLACE | $1,409 |
| AETNA | AETNA MARKETPLACE | $1,409 |
| AETNA | AETNA MARKETPLACE | $1,409 |
| AETNA | AETNA MARKETPLACE | $1,409 |
| AETNA | AETNA MARKETPLACE | $1,409 |
| AETNA | AETNA MARKETPLACE | $1,409 |
| AETNA | AETNA MARKETPLACE | $1,409 |
| AETNA | AETNA MARKETPLACE | $1,409 |
| AETNA | AETNA MARKETPLACE | $1,409 |
| AETNA | AETNA MARKETPLACE | $1,409 |
| WC BROWARD COUNTY | WORKERS COMP | $1,419.72 |
| WC CORVEL | WORKERS COMP | $1,419.72 |
| WC CORVEL | WORKERS COMP | $1,419.72 |
| WC BROWARD COUNTY | WORKERS COMP | $1,419.72 |
| WC CORVEL | WORKERS COMP | $1,419.72 |
| WC BROWARD COUNTY | WORKERS COMP | $1,419.72 |
| WC CORVEL | WORKERS COMP | $1,419.72 |
| WC BROWARD COUNTY | WORKERS COMP | $1,419.72 |
| WC CORVEL | WORKERS COMP | $1,419.72 |
| WC BROWARD COUNTY | WORKERS COMP | $1,419.72 |
| WC HERITAGE SUMMIT | WORKERS COMP | $1,449.61 |
| WC HERITAGE SUMMIT | WORKERS COMP | $1,449.61 |
| WC HERITAGE SUMMIT | WORKERS COMP | $1,449.61 |
| WC HERITAGE SUMMIT | WORKERS COMP | $1,449.61 |
| WC HERITAGE SUMMIT | WORKERS COMP | $1,449.61 |
| FIRST HEALTH | FIRST HEALTH INTERNATIONAL | $1,472.71 |
| EMBLEM HEALTH | FIRST HEALTH | $1,518.57 |
| CONNECTICARE | FIRST HEALTH | $1,518.57 |
| FIRST HEALTH | FIRST HEALTH | $1,518.57 |
| CONNECTICARE | FIRST HEALTH | $1,518.57 |
| EMBLEM HEALTH | FIRST HEALTH | $1,518.57 |
| FIRST HEALTH | FIRST HEALTH | $1,518.57 |
| FIRST HEALTH | FIRST HEALTH | $1,518.57 |
| EMBLEM HEALTH | FIRST HEALTH | $1,518.57 |
| CONNECTICARE | FIRST HEALTH | $1,518.57 |
| QUALITY HEALTH MANAGEMENT | INTERNATIONAL | $1,552.20 |
| AXIS SERVICES | INTERNATIONAL | $1,552.20 |
| GLOBAL MEDICAL MANAGEMENT | INTERNATIONAL | $1,552.20 |
| CMN GLOBAL | INTERNATIONAL | $1,552.20 |
| AXA ASSISTANCE US | INTERNATIONAL | $1,552.20 |
| GLOBAL HEALTH CLAIM SERVICES | INTERNATIONAL | $1,552.20 |
| GLOBAL BENEFITS GROUP | GLOBAL BENEFITS PLAN | $1,552.20 |
| PENFIELD CARE | INTERNATIONAL | $1,552.20 |
| SANUS HEALTHCARE | SANUS HEALTH MAINTENANCE ADMINISTRATORS | $1,552.20 |
| NATIONAL HEALTHCARE SOLUTIONS | INTERNATIONAL | $1,552.20 |
| MORGAN WHITE ADMINISTRATORS | MORGAN WHITE ADMINISTRATORS | $1,552.20 |
| DESJARDINS FINANCIAL SECURITY LIFE ASSURANCE | INTERNATIONAL | $1,552.20 |
| ALLIANZ GLOBAL ASSISTANCE | INTERNATIONAL | $1,552.20 |
| OLYMPUS MANAGED HEALTH CARE | INTERNATIONAL | $1,552.20 |
| WW CONCIERGE HEALTHCARE SERVICE | INTERNATIONAL | $1,552.20 |
| GUARDIAN | INTERNATIONAL | $1,552.20 |
| WW CONCIERGE HEALTHCARE SERVICE | INTERNATIONAL | $1,552.20 |
| OLYMPUS MANAGED HEALTH CARE | INTERNATIONAL | $1,552.20 |
| AXA ASSISTANCE US | INTERNATIONAL | $1,552.20 |
| GLOBAL HEALTH CLAIM SERVICES | INTERNATIONAL | $1,552.20 |
| SANUS HEALTHCARE | SANUS HEALTH MAINTENANCE ADMINISTRATORS | $1,552.20 |
| AXIS SERVICES | INTERNATIONAL | $1,552.20 |
| QUALITY HEALTH MANAGEMENT | INTERNATIONAL | $1,552.20 |
| NATIONAL HEALTHCARE SOLUTIONS | INTERNATIONAL | $1,552.20 |
| MORGAN WHITE ADMINISTRATORS | MORGAN WHITE ADMINISTRATORS | $1,552.20 |
| DESJARDINS FINANCIAL SECURITY LIFE ASSURANCE | INTERNATIONAL | $1,552.20 |
| GUARDIAN | INTERNATIONAL | $1,552.20 |
| CMN GLOBAL | INTERNATIONAL | $1,552.20 |
| GLOBAL MEDICAL MANAGEMENT | INTERNATIONAL | $1,552.20 |
| PENFIELD CARE | INTERNATIONAL | $1,552.20 |
| GLOBAL BENEFITS GROUP | GLOBAL BENEFITS PLAN | $1,552.20 |
| ALLIANZ GLOBAL ASSISTANCE | INTERNATIONAL | $1,552.20 |
| CMN GLOBAL | INTERNATIONAL | $1,552.20 |
| GLOBAL MEDICAL MANAGEMENT | INTERNATIONAL | $1,552.20 |
| GUARDIAN | INTERNATIONAL | $1,552.20 |
| GLOBAL HEALTH CLAIM SERVICES | INTERNATIONAL | $1,552.20 |
| ALLIANZ GLOBAL ASSISTANCE | INTERNATIONAL | $1,552.20 |
| AXIS SERVICES | INTERNATIONAL | $1,552.20 |
| QUALITY HEALTH MANAGEMENT | INTERNATIONAL | $1,552.20 |
| GLOBAL BENEFITS GROUP | GLOBAL BENEFITS PLAN | $1,552.20 |
| PENFIELD CARE | INTERNATIONAL | $1,552.20 |
| SANUS HEALTHCARE | SANUS HEALTH MAINTENANCE ADMINISTRATORS | $1,552.20 |
| NATIONAL HEALTHCARE SOLUTIONS | INTERNATIONAL | $1,552.20 |
| MORGAN WHITE ADMINISTRATORS | MORGAN WHITE ADMINISTRATORS | $1,552.20 |
| DESJARDINS FINANCIAL SECURITY LIFE ASSURANCE | INTERNATIONAL | $1,552.20 |
| OLYMPUS MANAGED HEALTH CARE | INTERNATIONAL | $1,552.20 |
| WW CONCIERGE HEALTHCARE SERVICE | INTERNATIONAL | $1,552.20 |
| AXA ASSISTANCE US | INTERNATIONAL | $1,552.20 |
| CIGNA | CIGNA IFP | $1,591 |
| CIGNA | CIGNA IFP | $1,591 |
| CIGNA | CIGNA IFP | $1,591 |
| CIGNA | CIGNA IFP | $1,591 |
| CIGNA | CIGNA IFP | $1,591 |
| CIGNA | CIGNA IFP | $1,591 |
| CIGNA | CIGNA IFP | $1,591 |
| CIGNA | CIGNA IFP | $1,591 |
| CIGNA | CIGNA IFP | $1,591 |
| CIGNA | CIGNA IFP | $1,591 |
| SUNMED INTERNATIONAL | SUNMED INTERNATIONAL | $1,603.94 |
| SUNMED INTERNATIONAL | SUNMED INTERNATIONAL | $1,603.94 |
| SUNMED INTERNATIONAL | SUNMED INTERNATIONAL | $1,603.94 |
| INTERNATIONAL GENERIC | STAR HEALTHCARE NETWORK PPO | $1,681.55 |
| INTERNATIONAL GENERIC | STAR HEALTHCARE NETWORK PPO | $1,681.55 |
| INTERNATIONAL GENERIC | STAR HEALTHCARE NETWORK PPO | $1,681.55 |
| UNITED HEALTHCARE | UNITED HEALTHCARE HMO CHOICE PLUS | $1,739 |
| UNITED HEALTHCARE | UNITED HEALTHCARE HMO CHOICE PLUS | $1,739 |
| GEHA | UNITED HEALTHCARE HMO CHOICE PLUS | $1,739 |
| GEHA | UNITED HEALTHCARE HMO CHOICE PLUS | $1,739 |
| UNITED HEALTHCARE | UNITED HEALTHCARE HMO CHOICE PLUS | $1,739 |
| UNITED HEALTHCARE | UNITED HEALTHCARE HMO CHOICE PLUS | $1,739 |
| GEHA | UNITED HEALTHCARE HMO CHOICE PLUS | $1,739 |
| GEHA | UNITED HEALTHCARE HMO CHOICE PLUS | $1,739 |
| UNITED HEALTHCARE | UNITED HEALTHCARE HMO CHOICE PLUS | $1,739 |
| UNITED HEALTHCARE | UNITED HEALTHCARE HMO CHOICE PLUS | $1,739 |
| GEHA | UNITED HEALTHCARE HMO CHOICE PLUS | $1,739 |
| GEHA | UNITED HEALTHCARE HMO CHOICE PLUS | $1,739 |
| UNITED HEALTHCARE | UNITED HEALTHCARE HMO CHOICE PLUS | $1,739 |
| UNITED HEALTHCARE | UNITED HEALTHCARE HMO CHOICE PLUS | $1,739 |
| GEHA | UNITED HEALTHCARE HMO CHOICE PLUS | $1,739 |
| GEHA | UNITED HEALTHCARE HMO CHOICE PLUS | $1,739 |
| GEHA | UNITED HEALTHCARE HMO CHOICE PLUS | $1,739 |
| GEHA | UNITED HEALTHCARE HMO CHOICE PLUS | $1,739 |
| UNITED HEALTHCARE | UNITED HEALTHCARE HMO CHOICE PLUS | $1,739 |
| UNITED HEALTHCARE | UNITED HEALTHCARE HMO CHOICE PLUS | $1,739 |
| CIGNA | CIGNA SUREFIT | $1,763 |
| CIGNA | CIGNA SUREFIT | $1,763 |
| CIGNA | CIGNA SUREFIT | $1,763 |
| CIGNA | CIGNA SUREFIT | $1,763 |
| CIGNA | CIGNA SUREFIT | $1,763 |
| CIGNA | CIGNA SUREFIT | $1,763 |
| CIGNA | CIGNA SUREFIT | $1,763 |
| CIGNA | CIGNA SUREFIT | $1,763 |
| CIGNA | CIGNA SUREFIT | $1,763 |
| CIGNA | CIGNA SUREFIT | $1,763 |
| UNICARE | PHCS | $1,810.90 |
| PHCS | PHCS | $1,810.90 |
| PHCS | PHCS | $1,810.90 |
| UNICARE | PHCS | $1,810.90 |
| UNICARE | PHCS | $1,810.90 |
| PHCS | PHCS | $1,810.90 |
| BRIDGE HEALTH | BRIDGE HEALTH MEDICAL | $1,845.50 |
| AETNA | AETNA GLOBAL BENEFITS | $1,852.88 |
| MERITAIN | AETNA COVENTRY | $1,880 |
| MERITAIN | AETNA COVENTRY | $1,880 |
| AETNA | AETNA COVENTRY | $1,880 |
| AETNA | AETNA COVENTRY | $1,880 |
| ALLIED BENEFIT SYSTEMS | AETNA COVENTRY | $1,880 |
| ALLIED BENEFIT SYSTEMS | AETNA COVENTRY | $1,880 |
| COVENTRY | AETNA COVENTRY | $1,880 |
| COVENTRY | AETNA COVENTRY | $1,880 |
| MERITAIN | AETNA COVENTRY | $1,880 |
| MERITAIN | AETNA COVENTRY | $1,880 |
| ALLIED BENEFIT SYSTEMS | AETNA COVENTRY | $1,880 |
| COVENTRY | AETNA COVENTRY | $1,880 |
| COVENTRY | AETNA COVENTRY | $1,880 |
| AETNA | AETNA COVENTRY | $1,880 |
| AETNA | AETNA COVENTRY | $1,880 |
| ALLIED BENEFIT SYSTEMS | AETNA COVENTRY | $1,880 |
| MERITAIN | AETNA COVENTRY | $1,880 |
| MERITAIN | AETNA COVENTRY | $1,880 |
| ALLIED BENEFIT SYSTEMS | AETNA COVENTRY | $1,880 |
| ALLIED BENEFIT SYSTEMS | AETNA COVENTRY | $1,880 |
| AETNA | AETNA COVENTRY | $1,880 |
| COVENTRY | AETNA COVENTRY | $1,880 |
| COVENTRY | AETNA COVENTRY | $1,880 |
| AETNA | AETNA COVENTRY | $1,880 |
| MERITAIN | AETNA COVENTRY | $1,880 |
| MERITAIN | AETNA COVENTRY | $1,880 |
| COVENTRY | AETNA COVENTRY | $1,880 |
| COVENTRY | AETNA COVENTRY | $1,880 |
| ALLIED BENEFIT SYSTEMS | AETNA COVENTRY | $1,880 |
| ALLIED BENEFIT SYSTEMS | AETNA COVENTRY | $1,880 |
| AETNA | AETNA COVENTRY | $1,880 |
| AETNA | AETNA COVENTRY | $1,880 |
| MERITAIN | AETNA COVENTRY | $1,880 |
| ALLIED BENEFIT SYSTEMS | AETNA COVENTRY | $1,880 |
| COVENTRY | AETNA COVENTRY | $1,880 |
| COVENTRY | AETNA COVENTRY | $1,880 |
| AETNA | AETNA COVENTRY | $1,880 |
| AETNA | AETNA COVENTRY | $1,880 |
| ALLIED BENEFIT SYSTEMS | AETNA COVENTRY | $1,880 |
| MERITAIN | AETNA COVENTRY | $1,880 |
| MVP | CIGNA HMO/PPO | $1,981 |
| MVP | CIGNA HMO/PPO | $1,981 |
| CIGNA | CIGNA HMO/PPO | $1,981 |
| CIGNA | CIGNA HMO/PPO | $1,981 |
| UPMC HEALTH PLAN | CIGNA HMO/PPO | $1,981 |
| UPMC HEALTH PLAN | CIGNA HMO/PPO | $1,981 |
| MVP | CIGNA HMO/PPO | $1,981 |
| MVP | CIGNA HMO/PPO | $1,981 |
| UPMC HEALTH PLAN | CIGNA HMO/PPO | $1,981 |
| UPMC HEALTH PLAN | CIGNA HMO/PPO | $1,981 |
| CIGNA | CIGNA HMO/PPO | $1,981 |
| CIGNA | CIGNA HMO/PPO | $1,981 |
| CIGNA | CIGNA HMO/PPO | $1,981 |
| CIGNA | CIGNA HMO/PPO | $1,981 |
| UPMC HEALTH PLAN | CIGNA HMO/PPO | $1,981 |
| UPMC HEALTH PLAN | CIGNA HMO/PPO | $1,981 |
| MVP | CIGNA HMO/PPO | $1,981 |
| MVP | CIGNA HMO/PPO | $1,981 |
| UPMC HEALTH PLAN | CIGNA HMO/PPO | $1,981 |
| UPMC HEALTH PLAN | CIGNA HMO/PPO | $1,981 |
| MVP | CIGNA HMO/PPO | $1,981 |
| MVP | CIGNA HMO/PPO | $1,981 |
| CIGNA | CIGNA HMO/PPO | $1,981 |
| CIGNA | CIGNA HMO/PPO | $1,981 |
| MVP | CIGNA HMO/PPO | $1,981 |
| MVP | CIGNA HMO/PPO | $1,981 |
| CIGNA | CIGNA HMO/PPO | $1,981 |
| CIGNA | CIGNA HMO/PPO | $1,981 |
| UPMC HEALTH PLAN | CIGNA HMO/PPO | $1,981 |
| UPMC HEALTH PLAN | CIGNA HMO/PPO | $1,981 |
| MEMORIAL INTEGRATED HEALTH | MEMORIAL HEALTH SYSTEM | $1,990.19 |
| COMMUNITY CARE PLAN | MEMORIAL HEALTH SYSTEM | $1,990.19 |
| CONNECTICARE | FIRST HEALTH | $2,166.62 |
| EMBLEM HEALTH | FIRST HEALTH | $2,166.62 |
| FIRST HEALTH | FIRST HEALTH | $2,166.62 |
| PENFIELD CARE | INTERNATIONAL | $2,214.60 |
| NATIONAL HEALTHCARE SOLUTIONS | INTERNATIONAL | $2,214.60 |
| DESJARDINS FINANCIAL SECURITY LIFE ASSURANCE | INTERNATIONAL | $2,214.60 |
| OLYMPUS MANAGED HEALTH CARE | INTERNATIONAL | $2,214.60 |
| AXA ASSISTANCE US | INTERNATIONAL | $2,214.60 |
| WW CONCIERGE HEALTHCARE SERVICE | INTERNATIONAL | $2,214.60 |
| GLOBAL HEALTH CLAIM SERVICES | INTERNATIONAL | $2,214.60 |
| SANUS HEALTHCARE | SANUS HEALTH MAINTENANCE ADMINISTRATORS | $2,214.60 |
| MORGAN WHITE ADMINISTRATORS | MORGAN WHITE ADMINISTRATORS | $2,214.60 |
| AXIS SERVICES | INTERNATIONAL | $2,214.60 |
| CMN GLOBAL | INTERNATIONAL | $2,214.60 |
| GLOBAL MEDICAL MANAGEMENT | INTERNATIONAL | $2,214.60 |
| GUARDIAN | INTERNATIONAL | $2,214.60 |
| ALLIANZ GLOBAL ASSISTANCE | INTERNATIONAL | $2,214.60 |
| GLOBAL BENEFITS GROUP | GLOBAL BENEFITS PLAN | $2,214.60 |
| QUALITY HEALTH MANAGEMENT | INTERNATIONAL | $2,214.60 |
| BLUE CROSS - FL | BCBS MY BLUE | $2,273 |
| BLUE CROSS - FL | BCBS MY BLUE | $2,273 |
| BLUE CROSS - FL | BCBS MY BLUE | $2,273 |
| BLUE CROSS - FL | BCBS MY BLUE | $2,273 |
| BLUE CROSS - FL | BCBS MY BLUE | $2,273 |
| BLUE CROSS - FL | BCBS MY BLUE | $2,273 |
| BLUE CROSS - FL | BCBS MY BLUE | $2,273 |
| BLUE CROSS - FL | BCBS MY BLUE | $2,273 |
| BLUE CROSS - FL | BCBS MY BLUE | $2,273 |
| BLUE CROSS - FL | BCBS MY BLUE | $2,273 |
| SUNMED INTERNATIONAL | SUNMED INTERNATIONAL | $2,288.42 |
| INTERNATIONAL GENERIC | STAR HEALTHCARE NETWORK PPO | $2,399.15 |
| MULTIPLAN | DIMENSION HEALTH MULTIPLAN | $2,457.65 |
| MULTIPLAN | BEECH STREET | $2,457.65 |
| MULTIPLAN | BEECH STREET | $2,457.65 |
| MULTIPLAN | DIMENSION HEALTH MULTIPLAN | $2,457.65 |
| MULTIPLAN | BEECH STREET | $2,457.65 |
| MULTIPLAN | DIMENSION HEALTH MULTIPLAN | $2,457.65 |
| PHCS | PHCS | $2,583.70 |
| UNICARE | PHCS | $2,583.70 |
| HEARTLAND HOSPICE | HEARTLAND HOSPICE | $2,587 |
| COMMUNITY CARE PLAN | CCP BROWARD HEART | $2,587 |
| COMMUNITY CARE PLAN MEDICAID ADVANTAGE | COMMUNITY CARE PLAN MEDICAID | $2,587 |
| GENERAL ELECTRIC | GENERAL ELECTRIC | $2,587 |
| SUNBELT INTERNATIONAL | SUNBELT INTERNATIONAL | $2,587 |
| WELLCARE MEDICAID | SUNSHINE STATE HEALTH PLAN MEDICAID | $2,587 |
| SUNSHINE STATE HEALTH PLAN | SUNSHINE STATE HEALTH PLAN MEDICAID | $2,587 |
| HUMANA MEDICAID | HUMANA MEDICAID HMO | $2,587 |
| HOSPICE VITAS | VITAS HEALTHCARE HOSPICE | $2,587 |
| GENERAL ELECTRIC | GENERAL ELECTRIC | $2,587 |
| SUNBELT INTERNATIONAL | SUNBELT INTERNATIONAL | $2,587 |
| HEARTLAND HOSPICE | HEARTLAND HOSPICE | $2,587 |
| HOSPICE VITAS | VITAS HEALTHCARE HOSPICE | $2,587 |
| COMMUNITY CARE PLAN | CCP BROWARD HEART | $2,587 |
| COMMUNITY CARE PLAN MEDICAID ADVANTAGE | COMMUNITY CARE PLAN MEDICAID | $2,587 |
| HUMANA MEDICAID | HUMANA MEDICAID HMO | $2,587 |
| SUNSHINE STATE HEALTH PLAN | SUNSHINE STATE HEALTH PLAN MEDICAID | $2,587 |
| WELLCARE MEDICAID | SUNSHINE STATE HEALTH PLAN MEDICAID | $2,587 |
| COMMUNITY CARE PLAN | CCP BROWARD HEART | $2,587 |
| GENERAL ELECTRIC | GENERAL ELECTRIC | $2,587 |
| SUNBELT INTERNATIONAL | SUNBELT INTERNATIONAL | $2,587 |
| HEARTLAND HOSPICE | HEARTLAND HOSPICE | $2,587 |
| HOSPICE VITAS | VITAS HEALTHCARE HOSPICE | $2,587 |
| HUMANA MEDICAID | HUMANA MEDICAID HMO | $2,587 |
| SUNSHINE STATE HEALTH PLAN | SUNSHINE STATE HEALTH PLAN MEDICAID | $2,587 |
| COMMUNITY CARE PLAN MEDICAID ADVANTAGE | COMMUNITY CARE PLAN MEDICAID | $2,587 |
| WELLCARE MEDICAID | SUNSHINE STATE HEALTH PLAN MEDICAID | $2,587 |
| BLUE CROSS - FL | BCBS HEALTH OPTIONS HMO | $2,716 |
| BLUE CROSS - FL | BCBS HEALTH OPTIONS HMO | $2,716 |
| BLUE CROSS - FL | BCBS HEALTH OPTIONS HMO | $2,716 |
| BLUE CROSS - FL | BCBS HEALTH OPTIONS HMO | $2,716 |
| BLUE CROSS - FL | BCBS HEALTH OPTIONS HMO | $2,716 |
| BLUE CROSS - FL | BCBS HEALTH OPTIONS HMO | $2,716 |
| BLUE CROSS - FL | BCBS HEALTH OPTIONS HMO | $2,716 |
| BLUE CROSS - FL | BCBS HEALTH OPTIONS HMO | $2,716 |
| BLUE CROSS - FL | BCBS HEALTH OPTIONS HMO | $2,716 |
| BLUE CROSS - FL | BCBS HEALTH OPTIONS HMO | $2,716 |
| BLUE CROSS - FL | BCBS NETWORK BLUE | $3,044 |
| BLUE CROSS - FL | BCBS NETWORK BLUE | $3,044 |
| BLUE CROSS - FL | BCBS NETWORK BLUE | $3,044 |
| BLUE CROSS - FL | BCBS NETWORK BLUE | $3,044 |
| BLUE CROSS - FL | BCBS NETWORK BLUE | $3,044 |
| BLUE CROSS - FL | BCBS NETWORK BLUE | $3,044 |
| BLUE CROSS - FL | BCBS NETWORK BLUE | $3,044 |
| BLUE CROSS - FL | BCBS NETWORK BLUE | $3,044 |
| BLUE CROSS - FL | BCBS NETWORK BLUE | $3,044 |
| BLUE CROSS - FL | BCBS NETWORK BLUE | $3,044 |
| BLUE CARE NETWORK | BCBS PPC | $3,406 |
| BLUE CARE NETWORK | BCBS PPC | $3,406 |
| BLUE CROSS - PA (INDEPENDENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - PA (INDEPENDENCE) | BCBS PPC | $3,406 |
| BLUE SHIELD - NY HIGHMARK WESTERN | BCBS PPC | $3,406 |
| BLUE SHIELD - NY HIGHMARK WESTERN | BCBS PPC | $3,406 |
| BLUE CROSS - NY (EXCELLUS) | BCBS PPC | $3,406 |
| BLUE CROSS - NY (EXCELLUS) | BCBS PPC | $3,406 |
| BLUE CROSS - NY (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - NY (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - NM | BCBS PPC | $3,406 |
| BLUE CROSS - NM | BCBS PPC | $3,406 |
| BLUE DISTINCTION TRANSPLANT | BCBS PPC | $3,406 |
| BLUE DISTINCTION TRANSPLANT | BCBS PPC | $3,406 |
| BCBS GENERIC | BCBS PPC | $3,406 |
| BCBS GENERIC | BCBS PPC | $3,406 |
| BLUE CROSS - FEDERAL | BCBS PPC | $3,406 |
| BLUE CROSS - FEDERAL | BCBS PPC | $3,406 |
| BLUE CROSS - WY | BCBS PPC | $3,406 |
| BLUE CROSS - WY | BCBS PPC | $3,406 |
| BLUE CROSS - DE (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - IA (WELLMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - DE (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - RI | BCBS PPC | $3,406 |
| BLUE CROSS - PA (CAPITAL) | BCBS PPC | $3,406 |
| BLUE CROSS - PA (CAPITAL) | BCBS PPC | $3,406 |
| BLUE CROSS - ID | BCBS PPC | $3,406 |
| BLUE CROSS - ID | BCBS PPC | $3,406 |
| BLUE CROSS - HI | BCBS PPC | $3,406 |
| BLUE CROSS - HI | BCBS PPC | $3,406 |
| BLUE CROSS - GA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - GA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - DC (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - AZ | BCBS PPC | $3,406 |
| BLUE CROSS - AZ | BCBS PPC | $3,406 |
| BLUE CROSS - IA (WELLMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - IL | BCBS PPC | $3,406 |
| HEALTH CHOICES | BCBS PPC | $3,406 |
| HEALTH CHOICES | BCBS PPC | $3,406 |
| BLUE CROSS - AR | BCBS PPC | $3,406 |
| BLUE CROSS - AR | BCBS PPC | $3,406 |
| BLUE CROSS - IL | BCBS PPC | $3,406 |
| BLUE CROSS - MN | BCBS PPC | $3,406 |
| BLUE CROSS - MN | BCBS PPC | $3,406 |
| BLUE CROSS - WI (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - WI (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - IL ALTERNATE | BCBS PPC | $3,406 |
| BLUE CROSS - IL ALTERNATE | BCBS PPC | $3,406 |
| BLUE CROSS - IN (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - IN (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - DC (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - CT (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - CT (ANTHEM) | BCBS PPC | $3,406 |
| BLUE SHIELD - WA (REGENCE) | BCBS PPC | $3,406 |
| BLUE SHIELD - WA (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - WA (PREMERA) | BCBS PPC | $3,406 |
| BLUE CROSS - WA (PREMERA) | BCBS PPC | $3,406 |
| BLUE CROSS - VA (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - VA (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - VT | BCBS PPC | $3,406 |
| BLUE CROSS - MS | BCBS PPC | $3,406 |
| BCN DOMESTIC | BCBS PPC | $3,406 |
| BCN DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS - VT | BCBS PPC | $3,406 |
| BLUE CROSS - VA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - VA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - UT (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - UT (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - TX | BCBS PPC | $3,406 |
| BLUE CROSS - TX | BCBS PPC | $3,406 |
| BLUE CROSS - TN | BCBS PPC | $3,406 |
| BLUE CROSS - TN | BCBS PPC | $3,406 |
| BLUE CROSS - SC | BCBS PPC | $3,406 |
| BLUE CROSS - SC | BCBS PPC | $3,406 |
| BLUE SHIELD - PA (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE SHIELD - PA (HIGHMARK) | BCBS PPC | $3,406 |
| KAISER DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS - RI | BCBS PPC | $3,406 |
| BLUE CROSS - WV (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - WV (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - MS | BCBS PPC | $3,406 |
| BLUE CROSS - NE | BCBS PPC | $3,406 |
| BLUE CROSS - NE | BCBS PPC | $3,406 |
| BLUE CROSS - OH (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - OH (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - MT | BCBS PPC | $3,406 |
| BLUE CROSS - MT | BCBS PPC | $3,406 |
| KAISER DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS - CO (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - CO (ANTHEM) | BCBS PPC | $3,406 |
| BLUE BENEFIT ADMINISTRATORS OF MASSACHUSETTS | BCBS PPC | $3,406 |
| BLUE BENEFIT ADMINISTRATORS OF MASSACHUSETTS | BCBS PPC | $3,406 |
| BLUE CROSS - NV (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - NV (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - SD (WELLMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - SD (WELLMARK) | BCBS PPC | $3,406 |
| WC DOMESTIC | BCBS PPC | $3,406 |
| WC DOMESTIC | BCBS PPC | $3,406 |
| PRE-EMPLOYMENT | BCBS PPC | $3,406 |
| PRE-EMPLOYMENT | BCBS PPC | $3,406 |
| BLUE CROSS - OK | BCBS PPC | $3,406 |
| BLUE CROSS - OK | BCBS PPC | $3,406 |
| BLUE CROSS - OR (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - OR (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - NC | BCBS PPC | $3,406 |
| BLUE CROSS - NC | BCBS PPC | $3,406 |
| BLUE SHIELD - NY HIGHMARK NORTHEASTERN | BCBS PPC | $3,406 |
| BLUE SHIELD - NY HIGHMARK NORTHEASTERN | BCBS PPC | $3,406 |
| BLUE CROSS - MA | BCBS PPC | $3,406 |
| BLUE CROSS - MA | BCBS PPC | $3,406 |
| BLUE CROSS - ME (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - ME (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - MD (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - MD (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - LA | BCBS PPC | $3,406 |
| BLUE CROSS - LA | BCBS PPC | $3,406 |
| BLUE CROSS - KY (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - KY (ANTHEM) | BCBS PPC | $3,406 |
| BLUE SHIELD - ID (REGENCE) | BCBS PPC | $3,406 |
| BLUE SHIELD - ID (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - NH (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - NH (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - AL | BCBS PPC | $3,406 |
| BLUE CROSS - MO (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - MO (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - KS | BCBS PPC | $3,406 |
| BLUE CROSS - MI | BCBS PPC | $3,406 |
| BLUE CROSS - NJ (HORIZON) | BCBS PPC | $3,406 |
| BLUE CROSS - NJ (HORIZON) | BCBS PPC | $3,406 |
| BLUE CROSS - AK (PREMERA) | BCBS PPC | $3,406 |
| BLUE CROSS - AK (PREMERA) | BCBS PPC | $3,406 |
| BLUE CROSS - AL | BCBS PPC | $3,406 |
| BLUE CROSS - ND | BCBS PPC | $3,406 |
| BLUE CROSS - KS | BCBS PPC | $3,406 |
| BLUE CROSS - ND | BCBS PPC | $3,406 |
| BLUE CROSS - MI | BCBS PPC | $3,406 |
| BLUE SHIELD - CA | BCBS PPC | $3,406 |
| BLUE SHIELD - CA | BCBS PPC | $3,406 |
| BLUE CROSS - CA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - CA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - HI | BCBS PPC | $3,406 |
| BLUE CROSS - HI | BCBS PPC | $3,406 |
| BLUE CROSS - GA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - GA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - ID | BCBS PPC | $3,406 |
| BLUE CROSS DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS DOMESTIC | BCBS PPC | $3,406 |
| BCN DOMESTIC | BCBS PPC | $3,406 |
| BLUE DISTINCTION TRANSPLANT | BCBS PPC | $3,406 |
| BLUE CARE NETWORK | BCBS PPC | $3,406 |
| BLUE CARE NETWORK | BCBS PPC | $3,406 |
| BLUE CROSS - NY (ANTHEM) | BCBS PPC | $3,406 |
| BLUE DISTINCTION TRANSPLANT | BCBS PPC | $3,406 |
| BLUE CROSS - ID | BCBS PPC | $3,406 |
| BLUE SHIELD - PA (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE SHIELD - PA (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - PA (CAPITAL) | BCBS PPC | $3,406 |
| BLUE CROSS - PA (CAPITAL) | BCBS PPC | $3,406 |
| BLUE CROSS - RI | BCBS PPC | $3,406 |
| BLUE CROSS - RI | BCBS PPC | $3,406 |
| BLUE CROSS - SC | BCBS PPC | $3,406 |
| BLUE CROSS - SC | BCBS PPC | $3,406 |
| BLUE CROSS - TN | BCBS PPC | $3,406 |
| BLUE CROSS - NY (ANTHEM) | BCBS PPC | $3,406 |
| BLUE SHIELD - NY HIGHMARK WESTERN | BCBS PPC | $3,406 |
| BLUE SHIELD - NY HIGHMARK WESTERN | BCBS PPC | $3,406 |
| BLUE CROSS - TN | BCBS PPC | $3,406 |
| BLUE CROSS - ND | BCBS PPC | $3,406 |
| BLUE CROSS - ND | BCBS PPC | $3,406 |
| BLUE CROSS - MO (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - MO (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - CT (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - CT (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - DE (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - DE (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - DC (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - DC (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE SHIELD - CA | BCBS PPC | $3,406 |
| BCBS GENERIC | BCBS PPC | $3,406 |
| BLUE CROSS - CA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - WY | BCBS PPC | $3,406 |
| BLUE CROSS - CA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - WY | BCBS PPC | $3,406 |
| BLUE CROSS - FEDERAL | BCBS PPC | $3,406 |
| BLUE CROSS - FEDERAL | BCBS PPC | $3,406 |
| BLUE SHIELD - ID (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - KY (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - KY (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - ME (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - ME (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - LA | BCBS PPC | $3,406 |
| BLUE CROSS - LA | BCBS PPC | $3,406 |
| BLUE CROSS - MD (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - MD (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - MA | BCBS PPC | $3,406 |
| BLUE CROSS - MA | BCBS PPC | $3,406 |
| BLUE SHIELD - NY HIGHMARK NORTHEASTERN | BCBS PPC | $3,406 |
| BLUE SHIELD - NY HIGHMARK NORTHEASTERN | BCBS PPC | $3,406 |
| BLUE CROSS - NC | BCBS PPC | $3,406 |
| BLUE CROSS - NC | BCBS PPC | $3,406 |
| BLUE CROSS - OR (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - OR (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - OK | BCBS PPC | $3,406 |
| BLUE CROSS - OK | BCBS PPC | $3,406 |
| BLUE CROSS - NM | BCBS PPC | $3,406 |
| BLUE CROSS - NM | BCBS PPC | $3,406 |
| BLUE CROSS - NY (EXCELLUS) | BCBS PPC | $3,406 |
| BLUE CROSS - NY (EXCELLUS) | BCBS PPC | $3,406 |
| BLUE CROSS - PA (INDEPENDENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - PA (INDEPENDENCE) | BCBS PPC | $3,406 |
| BCBS GENERIC | BCBS PPC | $3,406 |
| BLUE CROSS - AR | BCBS PPC | $3,406 |
| BLUE CROSS - AR | BCBS PPC | $3,406 |
| BLUE SHIELD - CA | BCBS PPC | $3,406 |
| WC DOMESTIC | BCBS PPC | $3,406 |
| WC DOMESTIC | BCBS PPC | $3,406 |
| PRE-EMPLOYMENT | BCBS PPC | $3,406 |
| PRE-EMPLOYMENT | BCBS PPC | $3,406 |
| BCN DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS - MI | BCBS PPC | $3,406 |
| BLUE CROSS - MI | BCBS PPC | $3,406 |
| BLUE CROSS - KS | BCBS PPC | $3,406 |
| BLUE CROSS - KS | BCBS PPC | $3,406 |
| BLUE CROSS - IL ALTERNATE | BCBS PPC | $3,406 |
| BLUE CROSS - IL ALTERNATE | BCBS PPC | $3,406 |
| BLUE CROSS - IN (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - IN (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - WI (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - WI (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - MN | BCBS PPC | $3,406 |
| BLUE CROSS - MN | BCBS PPC | $3,406 |
| BLUE CROSS - CO (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - CO (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - WV (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - WV (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE BENEFIT ADMINISTRATORS OF MASSACHUSETTS | BCBS PPC | $3,406 |
| BLUE BENEFIT ADMINISTRATORS OF MASSACHUSETTS | BCBS PPC | $3,406 |
| BLUE SHIELD - ID (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - TX | BCBS PPC | $3,406 |
| BLUE CROSS - TX | BCBS PPC | $3,406 |
| BLUE CROSS - VT | BCBS PPC | $3,406 |
| BLUE CROSS - VT | BCBS PPC | $3,406 |
| BLUE CROSS - UT (REGENCE) | BCBS PPC | $3,406 |
| KAISER DOMESTIC | BCBS PPC | $3,406 |
| KAISER DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS - UT (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - VA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - VA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - VA (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - VA (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - WA (PREMERA) | BCBS PPC | $3,406 |
| BLUE CROSS - WA (PREMERA) | BCBS PPC | $3,406 |
| BLUE SHIELD - WA (REGENCE) | BCBS PPC | $3,406 |
| BLUE SHIELD - WA (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - IA (WELLMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - IA (WELLMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - IL | BCBS PPC | $3,406 |
| BLUE CROSS - IL | BCBS PPC | $3,406 |
| BLUE CROSS - MS | BCBS PPC | $3,406 |
| BLUE CROSS - AL | BCBS PPC | $3,406 |
| BLUE CROSS - AL | BCBS PPC | $3,406 |
| BLUE CROSS - NH (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - NH (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - SD (WELLMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - NV (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - NV (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - OH (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - OH (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - MT | BCBS PPC | $3,406 |
| BLUE CROSS - MT | BCBS PPC | $3,406 |
| BLUE CROSS - NE | BCBS PPC | $3,406 |
| BLUE CROSS - NE | BCBS PPC | $3,406 |
| BLUE CROSS - MS | BCBS PPC | $3,406 |
| HEALTH CHOICES | BCBS PPC | $3,406 |
| HEALTH CHOICES | BCBS PPC | $3,406 |
| BLUE CROSS - AZ | BCBS PPC | $3,406 |
| BLUE CROSS - AZ | BCBS PPC | $3,406 |
| BLUE CROSS - AK (PREMERA) | BCBS PPC | $3,406 |
| BLUE CROSS - AK (PREMERA) | BCBS PPC | $3,406 |
| BLUE CROSS - NJ (HORIZON) | BCBS PPC | $3,406 |
| BLUE CROSS - NJ (HORIZON) | BCBS PPC | $3,406 |
| BLUE CROSS - SD (WELLMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - NY (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - NY (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - PA (INDEPENDENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - PA (INDEPENDENCE) | BCBS PPC | $3,406 |
| WC DOMESTIC | BCBS PPC | $3,406 |
| WC DOMESTIC | BCBS PPC | $3,406 |
| PRE-EMPLOYMENT | BCBS PPC | $3,406 |
| PRE-EMPLOYMENT | BCBS PPC | $3,406 |
| BLUE SHIELD - CA | BCBS PPC | $3,406 |
| BLUE SHIELD - CA | BCBS PPC | $3,406 |
| BLUE BENEFIT ADMINISTRATORS OF MASSACHUSETTS | BCBS PPC | $3,406 |
| BLUE BENEFIT ADMINISTRATORS OF MASSACHUSETTS | BCBS PPC | $3,406 |
| BLUE SHIELD - ID (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - CA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - CA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - AR | BCBS PPC | $3,406 |
| BLUE CROSS - AR | BCBS PPC | $3,406 |
| HEALTH CHOICES | BCBS PPC | $3,406 |
| HEALTH CHOICES | BCBS PPC | $3,406 |
| BCBS GENERIC | BCBS PPC | $3,406 |
| BCBS GENERIC | BCBS PPC | $3,406 |
| BLUE CROSS - FEDERAL | BCBS PPC | $3,406 |
| BLUE CROSS - FEDERAL | BCBS PPC | $3,406 |
| BLUE CROSS - WY | BCBS PPC | $3,406 |
| BLUE CROSS - WY | BCBS PPC | $3,406 |
| BLUE SHIELD - ID (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - TX | BCBS PPC | $3,406 |
| BLUE CROSS - IL | BCBS PPC | $3,406 |
| BLUE CROSS - MN | BCBS PPC | $3,406 |
| BLUE CROSS - MN | BCBS PPC | $3,406 |
| BLUE CROSS - KS | BCBS PPC | $3,406 |
| BLUE CROSS - IL ALTERNATE | BCBS PPC | $3,406 |
| BLUE CROSS - IL ALTERNATE | BCBS PPC | $3,406 |
| BLUE CROSS - IN (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - IN (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - IL | BCBS PPC | $3,406 |
| BLUE CROSS - MI | BCBS PPC | $3,406 |
| BLUE CROSS - TX | BCBS PPC | $3,406 |
| BLUE CROSS - WI (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - WI (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - KS | BCBS PPC | $3,406 |
| BLUE CROSS - MI | BCBS PPC | $3,406 |
| BCN DOMESTIC | BCBS PPC | $3,406 |
| BCN DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS - VT | BCBS PPC | $3,406 |
| BLUE CROSS - VT | BCBS PPC | $3,406 |
| BLUE CROSS - UT (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - UT (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - VA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - VA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - VA (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - VA (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE SHIELD - WA (REGENCE) | BCBS PPC | $3,406 |
| BLUE SHIELD - WA (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - WA (PREMERA) | BCBS PPC | $3,406 |
| BLUE CROSS - WA (PREMERA) | BCBS PPC | $3,406 |
| BLUE CARE NETWORK | BCBS PPC | $3,406 |
| BLUE CARE NETWORK | BCBS PPC | $3,406 |
| BLUE CROSS - NY (EXCELLUS) | BCBS PPC | $3,406 |
| BLUE CROSS - NY (EXCELLUS) | BCBS PPC | $3,406 |
| BLUE SHIELD - NY HIGHMARK WESTERN | BCBS PPC | $3,406 |
| BLUE SHIELD - NY HIGHMARK WESTERN | BCBS PPC | $3,406 |
| BLUE CROSS - HI | BCBS PPC | $3,406 |
| BLUE CROSS - HI | BCBS PPC | $3,406 |
| BLUE CROSS - GA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - GA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - ID | BCBS PPC | $3,406 |
| BLUE CROSS - ID | BCBS PPC | $3,406 |
| BLUE CROSS - PA (CAPITAL) | BCBS PPC | $3,406 |
| BLUE CROSS - PA (CAPITAL) | BCBS PPC | $3,406 |
| BLUE CROSS - RI | BCBS PPC | $3,406 |
| BLUE SHIELD - PA (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE SHIELD - PA (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - SC | BCBS PPC | $3,406 |
| BLUE CROSS - SC | BCBS PPC | $3,406 |
| BLUE CROSS - RI | BCBS PPC | $3,406 |
| BLUE CROSS - TN | BCBS PPC | $3,406 |
| BLUE CROSS - TN | BCBS PPC | $3,406 |
| BLUE CROSS - ND | BCBS PPC | $3,406 |
| BLUE CROSS - ND | BCBS PPC | $3,406 |
| BLUE CROSS - MO (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - MO (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - NM | BCBS PPC | $3,406 |
| BLUE CROSS - NM | BCBS PPC | $3,406 |
| BLUE CROSS - CT (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - CT (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - DE (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - DE (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - DC (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - DC (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - WV (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - WV (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - KY (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - KY (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - LA | BCBS PPC | $3,406 |
| BLUE CROSS - LA | BCBS PPC | $3,406 |
| BLUE CROSS - MD (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - MD (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - ME (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - ME (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - MA | BCBS PPC | $3,406 |
| BLUE CROSS - MA | BCBS PPC | $3,406 |
| BLUE SHIELD - NY HIGHMARK NORTHEASTERN | BCBS PPC | $3,406 |
| BLUE SHIELD - NY HIGHMARK NORTHEASTERN | BCBS PPC | $3,406 |
| BLUE CROSS - OK | BCBS PPC | $3,406 |
| BLUE CROSS - OK | BCBS PPC | $3,406 |
| BLUE CROSS - NC | BCBS PPC | $3,406 |
| BLUE CROSS - NC | BCBS PPC | $3,406 |
| BLUE CROSS - OR (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - OR (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - AZ | BCBS PPC | $3,406 |
| BLUE CROSS - AZ | BCBS PPC | $3,406 |
| KAISER DOMESTIC | BCBS PPC | $3,406 |
| KAISER DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS - IA (WELLMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - NV (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - NV (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - IA (WELLMARK) | BCBS PPC | $3,406 |
| BLUE DISTINCTION TRANSPLANT | BCBS PPC | $3,406 |
| BLUE DISTINCTION TRANSPLANT | BCBS PPC | $3,406 |
| BLUE CROSS - SD (WELLMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - SD (WELLMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - NH (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - NH (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - AL | BCBS PPC | $3,406 |
| BLUE CROSS - AL | BCBS PPC | $3,406 |
| BLUE CROSS - NJ (HORIZON) | BCBS PPC | $3,406 |
| BLUE CROSS - NJ (HORIZON) | BCBS PPC | $3,406 |
| BLUE CROSS - OH (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - OH (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - CO (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - CO (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - NE | BCBS PPC | $3,406 |
| BLUE CROSS - NE | BCBS PPC | $3,406 |
| BLUE CROSS - AK (PREMERA) | BCBS PPC | $3,406 |
| BLUE CROSS - AK (PREMERA) | BCBS PPC | $3,406 |
| BLUE CROSS - MS | BCBS PPC | $3,406 |
| BLUE CROSS - MS | BCBS PPC | $3,406 |
| BLUE CROSS - MT | BCBS PPC | $3,406 |
| BLUE CROSS - MT | BCBS PPC | $3,406 |
| BLUE CROSS - CO (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - CO (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - NE | BCBS PPC | $3,406 |
| BLUE CROSS - NE | BCBS PPC | $3,406 |
| BLUE CROSS - MS | BCBS PPC | $3,406 |
| BLUE CROSS - MS | BCBS PPC | $3,406 |
| BLUE CROSS - MT | BCBS PPC | $3,406 |
| BLUE CROSS - MT | BCBS PPC | $3,406 |
| BLUE CROSS - OH (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - OH (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - AL | BCBS PPC | $3,406 |
| BLUE CROSS - AL | BCBS PPC | $3,406 |
| BLUE CROSS - NJ (HORIZON) | BCBS PPC | $3,406 |
| BLUE CROSS - NJ (HORIZON) | BCBS PPC | $3,406 |
| PRE-EMPLOYMENT | BCBS PPC | $3,406 |
| PRE-EMPLOYMENT | BCBS PPC | $3,406 |
| BLUE SHIELD - CA | BCBS PPC | $3,406 |
| BLUE SHIELD - CA | BCBS PPC | $3,406 |
| BLUE CROSS - NY (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - NY (ANTHEM) | BCBS PPC | $3,406 |
| WC DOMESTIC | BCBS PPC | $3,406 |
| WC DOMESTIC | BCBS PPC | $3,406 |
| BLUE BENEFIT ADMINISTRATORS OF MASSACHUSETTS | BCBS PPC | $3,406 |
| BLUE BENEFIT ADMINISTRATORS OF MASSACHUSETTS | BCBS PPC | $3,406 |
| BLUE SHIELD - ID (REGENCE) | BCBS PPC | $3,406 |
| BLUE SHIELD - ID (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - MI | BCBS PPC | $3,406 |
| BLUE CROSS - MI | BCBS PPC | $3,406 |
| BLUE CROSS - IN (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - IN (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - IL ALTERNATE | BCBS PPC | $3,406 |
| BLUE CROSS - IL ALTERNATE | BCBS PPC | $3,406 |
| BLUE CROSS - KS | BCBS PPC | $3,406 |
| BLUE CROSS - KS | BCBS PPC | $3,406 |
| BLUE CROSS - ND | BCBS PPC | $3,406 |
| BLUE CROSS - ND | BCBS PPC | $3,406 |
| BLUE CROSS - MO (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - MO (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - CT (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - CT (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - DE (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - DE (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - NY (EXCELLUS) | BCBS PPC | $3,406 |
| BLUE CROSS - NY (EXCELLUS) | BCBS PPC | $3,406 |
| BLUE CROSS - DC (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - DC (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - HI | BCBS PPC | $3,406 |
| BLUE CROSS - HI | BCBS PPC | $3,406 |
| BLUE CROSS - GA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - GA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - ID | BCBS PPC | $3,406 |
| BLUE CROSS - ID | BCBS PPC | $3,406 |
| BLUE CROSS - PA (CAPITAL) | BCBS PPC | $3,406 |
| BLUE CROSS - PA (CAPITAL) | BCBS PPC | $3,406 |
| BLUE CROSS - FEDERAL | BCBS PPC | $3,406 |
| BLUE CROSS - FEDERAL | BCBS PPC | $3,406 |
| BCBS GENERIC | BCBS PPC | $3,406 |
| BCBS GENERIC | BCBS PPC | $3,406 |
| BLUE DISTINCTION TRANSPLANT | BCBS PPC | $3,406 |
| BLUE DISTINCTION TRANSPLANT | BCBS PPC | $3,406 |
| BLUE CARE NETWORK | BCBS PPC | $3,406 |
| BLUE CARE NETWORK | BCBS PPC | $3,406 |
| BLUE CROSS - WV (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - WV (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - KY (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - KY (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - LA | BCBS PPC | $3,406 |
| BLUE CROSS - LA | BCBS PPC | $3,406 |
| BLUE CROSS - MD (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - MD (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE SHIELD - PA (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE SHIELD - PA (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - SC | BCBS PPC | $3,406 |
| BLUE CROSS - SC | BCBS PPC | $3,406 |
| BLUE CROSS - RI | BCBS PPC | $3,406 |
| BLUE CROSS - RI | BCBS PPC | $3,406 |
| BLUE CROSS - IL | BCBS PPC | $3,406 |
| BLUE CROSS - IL | BCBS PPC | $3,406 |
| BLUE CROSS - MN | BCBS PPC | $3,406 |
| BCN DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS - NV (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - NV (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - ME (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - ME (ANTHEM) | BCBS PPC | $3,406 |
| BLUE SHIELD - NY HIGHMARK WESTERN | BCBS PPC | $3,406 |
| BLUE SHIELD - NY HIGHMARK WESTERN | BCBS PPC | $3,406 |
| BLUE CROSS - MA | BCBS PPC | $3,406 |
| BLUE CROSS - MA | BCBS PPC | $3,406 |
| BLUE SHIELD - NY HIGHMARK NORTHEASTERN | BCBS PPC | $3,406 |
| BLUE SHIELD - NY HIGHMARK NORTHEASTERN | BCBS PPC | $3,406 |
| BLUE CROSS - NC | BCBS PPC | $3,406 |
| BLUE CROSS - NC | BCBS PPC | $3,406 |
| BLUE CROSS - MN | BCBS PPC | $3,406 |
| KAISER DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS - WI (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - IA (WELLMARK) | BCBS PPC | $3,406 |
| KAISER DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS - AK (PREMERA) | BCBS PPC | $3,406 |
| BLUE CROSS - AK (PREMERA) | BCBS PPC | $3,406 |
| BLUE CROSS - OK | BCBS PPC | $3,406 |
| BLUE CROSS - OK | BCBS PPC | $3,406 |
| BLUE CROSS - PA (INDEPENDENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - PA (INDEPENDENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - OR (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - OR (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - IA (WELLMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - WI (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - AR | BCBS PPC | $3,406 |
| BLUE CROSS - AR | BCBS PPC | $3,406 |
| BLUE CROSS - AZ | BCBS PPC | $3,406 |
| BLUE CROSS - AZ | BCBS PPC | $3,406 |
| BLUE CROSS - TN | BCBS PPC | $3,406 |
| BLUE CROSS - TN | BCBS PPC | $3,406 |
| BLUE CROSS - CA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - CA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - TX | BCBS PPC | $3,406 |
| BLUE CROSS - TX | BCBS PPC | $3,406 |
| BLUE CROSS - VT | BCBS PPC | $3,406 |
| BLUE CROSS - VT | BCBS PPC | $3,406 |
| BLUE CROSS - UT (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - UT (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - VA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - VA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - VA (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - VA (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - WA (PREMERA) | BCBS PPC | $3,406 |
| BLUE CROSS - WY | BCBS PPC | $3,406 |
| BLUE CROSS - WY | BCBS PPC | $3,406 |
| BLUE CROSS - WA (PREMERA) | BCBS PPC | $3,406 |
| BLUE SHIELD - WA (REGENCE) | BCBS PPC | $3,406 |
| BLUE SHIELD - WA (REGENCE) | BCBS PPC | $3,406 |
| HEALTH CHOICES | BCBS PPC | $3,406 |
| HEALTH CHOICES | BCBS PPC | $3,406 |
| BLUE CROSS - SD (WELLMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - SD (WELLMARK) | BCBS PPC | $3,406 |
| BCN DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS - NH (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - NH (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - NM | BCBS PPC | $3,406 |
| BLUE CROSS - NM | BCBS PPC | $3,406 |
| BLUE CARE NETWORK | BCBS PPC | $3,406 |
| BLUE CARE NETWORK | BCBS PPC | $3,406 |
| BLUE CROSS - NC | BCBS PPC | $3,406 |
| BLUE CROSS - OK | BCBS PPC | $3,406 |
| BLUE CROSS - OK | BCBS PPC | $3,406 |
| BLUE CROSS - OR (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - OR (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - PA (INDEPENDENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - PA (INDEPENDENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - MA | BCBS PPC | $3,406 |
| BLUE CROSS - MA | BCBS PPC | $3,406 |
| BLUE SHIELD - NY HIGHMARK NORTHEASTERN | BCBS PPC | $3,406 |
| BLUE SHIELD - NY HIGHMARK NORTHEASTERN | BCBS PPC | $3,406 |
| BLUE CROSS - NC | BCBS PPC | $3,406 |
| BLUE CROSS - CO (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - CO (ANTHEM) | BCBS PPC | $3,406 |
| BLUE BENEFIT ADMINISTRATORS OF MASSACHUSETTS | BCBS PPC | $3,406 |
| BLUE BENEFIT ADMINISTRATORS OF MASSACHUSETTS | BCBS PPC | $3,406 |
| BLUE CROSS - WV (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - WV (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE SHIELD - ID (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - MT | BCBS PPC | $3,406 |
| BLUE CROSS - MT | BCBS PPC | $3,406 |
| BLUE CROSS - NE | BCBS PPC | $3,406 |
| BLUE CROSS - NE | BCBS PPC | $3,406 |
| BLUE CROSS - MS | BCBS PPC | $3,406 |
| BLUE SHIELD - ID (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - NV (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - NV (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - OH (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - OH (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - MS | BCBS PPC | $3,406 |
| BLUE CROSS - AL | BCBS PPC | $3,406 |
| BLUE CROSS - AL | BCBS PPC | $3,406 |
| BLUE CROSS - NH (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - NH (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - ND | BCBS PPC | $3,406 |
| BLUE CROSS - ND | BCBS PPC | $3,406 |
| BLUE CROSS - CT (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - SD (WELLMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - SD (WELLMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - AK (PREMERA) | BCBS PPC | $3,406 |
| BLUE CROSS - AK (PREMERA) | BCBS PPC | $3,406 |
| BLUE CROSS - CT (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - DE (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - NJ (HORIZON) | BCBS PPC | $3,406 |
| BLUE CROSS - NJ (HORIZON) | BCBS PPC | $3,406 |
| BLUE CROSS DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS DOMESTIC | BCBS PPC | $3,406 |
| BCN DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS - MN | BCBS PPC | $3,406 |
| BLUE CROSS - MI | BCBS PPC | $3,406 |
| BLUE CROSS - MI | BCBS PPC | $3,406 |
| BLUE CROSS - IL ALTERNATE | BCBS PPC | $3,406 |
| BLUE CROSS - DE (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - DC (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - DC (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - KY (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - KY (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - LA | BCBS PPC | $3,406 |
| BLUE CROSS - LA | BCBS PPC | $3,406 |
| BLUE CROSS - ME (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - ME (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - IL ALTERNATE | BCBS PPC | $3,406 |
| BLUE CROSS - IN (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - KS | BCBS PPC | $3,406 |
| BLUE CROSS - MD (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - MD (CAREFIRST) | BCBS PPC | $3,406 |
| PRE-EMPLOYMENT | BCBS PPC | $3,406 |
| PRE-EMPLOYMENT | BCBS PPC | $3,406 |
| WC DOMESTIC | BCBS PPC | $3,406 |
| HEALTH CHOICES | BCBS PPC | $3,406 |
| HEALTH CHOICES | BCBS PPC | $3,406 |
| WC DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS - SC | BCBS PPC | $3,406 |
| BLUE CROSS - SC | BCBS PPC | $3,406 |
| BLUE CROSS - TN | BCBS PPC | $3,406 |
| BLUE CROSS - TN | BCBS PPC | $3,406 |
| BLUE CROSS - TX | BCBS PPC | $3,406 |
| BLUE CROSS - TX | BCBS PPC | $3,406 |
| BLUE CROSS - UT (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - UT (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - VT | BCBS PPC | $3,406 |
| BLUE CROSS - VT | BCBS PPC | $3,406 |
| BLUE CROSS - VA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - VA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - AZ | BCBS PPC | $3,406 |
| BLUE CROSS - AZ | BCBS PPC | $3,406 |
| BLUE CROSS - VA (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - VA (CAREFIRST) | BCBS PPC | $3,406 |
| BLUE CROSS - WA (PREMERA) | BCBS PPC | $3,406 |
| BLUE CROSS - WA (PREMERA) | BCBS PPC | $3,406 |
| BLUE SHIELD - WA (REGENCE) | BCBS PPC | $3,406 |
| BLUE SHIELD - WA (REGENCE) | BCBS PPC | $3,406 |
| BLUE CROSS - MN | BCBS PPC | $3,406 |
| BCN DOMESTIC | BCBS PPC | $3,406 |
| KAISER DOMESTIC | BCBS PPC | $3,406 |
| KAISER DOMESTIC | BCBS PPC | $3,406 |
| BLUE CROSS - GA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - GA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - HI | BCBS PPC | $3,406 |
| BLUE CROSS - HI | BCBS PPC | $3,406 |
| BLUE CROSS - ID | BCBS PPC | $3,406 |
| BLUE CROSS - ID | BCBS PPC | $3,406 |
| BLUE CROSS - PA (CAPITAL) | BCBS PPC | $3,406 |
| BLUE CROSS - PA (CAPITAL) | BCBS PPC | $3,406 |
| BLUE CROSS - IA (WELLMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - IA (WELLMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - IL | BCBS PPC | $3,406 |
| BLUE CROSS - IL | BCBS PPC | $3,406 |
| BLUE CROSS - MO (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - KS | BCBS PPC | $3,406 |
| BLUE CROSS - MO (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - IN (ANTHEM) | BCBS PPC | $3,406 |
| BLUE SHIELD - CA | BCBS PPC | $3,406 |
| BLUE CROSS - WY | BCBS PPC | $3,406 |
| BLUE DISTINCTION TRANSPLANT | BCBS PPC | $3,406 |
| BLUE SHIELD - PA (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE SHIELD - PA (HIGHMARK) | BCBS PPC | $3,406 |
| BLUE CROSS - RI | BCBS PPC | $3,406 |
| BLUE CROSS - RI | BCBS PPC | $3,406 |
| BLUE CROSS - NM | BCBS PPC | $3,406 |
| BLUE CROSS - NM | BCBS PPC | $3,406 |
| BLUE CROSS - NY (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - NY (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - NY (EXCELLUS) | BCBS PPC | $3,406 |
| BLUE CROSS - NY (EXCELLUS) | BCBS PPC | $3,406 |
| BLUE SHIELD - NY HIGHMARK WESTERN | BCBS PPC | $3,406 |
| BLUE SHIELD - NY HIGHMARK WESTERN | BCBS PPC | $3,406 |
| BLUE CROSS - WI (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - WI (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - WY | BCBS PPC | $3,406 |
| BCBS GENERIC | BCBS PPC | $3,406 |
| BCBS GENERIC | BCBS PPC | $3,406 |
| BLUE CROSS - AR | BCBS PPC | $3,406 |
| BLUE CROSS - CA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - CA (ANTHEM) | BCBS PPC | $3,406 |
| BLUE CROSS - FEDERAL | BCBS PPC | $3,406 |
| BLUE CROSS - FEDERAL | BCBS PPC | $3,406 |
| BLUE SHIELD - CA | BCBS PPC | $3,406 |
| BLUE DISTINCTION TRANSPLANT | BCBS PPC | $3,406 |
| BLUE CROSS - AR | BCBS PPC | $3,406 |
| MULTIPLAN | DIMENSION HEALTH MULTIPLAN | $3,506.45 |
| MULTIPLAN | BEECH STREET | $3,506.45 |
| COMMUNITY CARE PLAN MEDICAID ADVANTAGE | COMMUNITY CARE PLAN MEDICAID | $3,691 |
| WELLCARE MEDICAID | SUNSHINE STATE HEALTH PLAN MEDICAID | $3,691 |
| HUMANA MEDICAID | HUMANA MEDICAID HMO | $3,691 |
| SUNSHINE STATE HEALTH PLAN | SUNSHINE STATE HEALTH PLAN MEDICAID | $3,691 |
| GENERAL ELECTRIC | GENERAL ELECTRIC | $3,691 |
| HOSPICE VITAS | VITAS HEALTHCARE HOSPICE | $3,691 |
| COMMUNITY CARE PLAN | CCP BROWARD HEART | $3,691 |
| SUNBELT INTERNATIONAL | SUNBELT INTERNATIONAL | $3,691 |
| HEARTLAND HOSPICE | HEARTLAND HOSPICE | $3,691 |
| BLUE CROSS - FL | BCBS TRADITIONAL PHS | $3,893 |
| BLUE CROSS - FL | BCBS TRADITIONAL PHS | $3,893 |
| BLUE CROSS - FL | BCBS TRADITIONAL PHS | $3,893 |
| BLUE CROSS - FL | BCBS TRADITIONAL PHS | $3,893 |
| BLUE CROSS - FL | BCBS TRADITIONAL PHS | $3,893 |
| BLUE CROSS - FL | BCBS TRADITIONAL PHS | $3,893 |
| BLUE CROSS - FL | BCBS TRADITIONAL PHS | $3,893 |
| BLUE CROSS - FL | BCBS TRADITIONAL PHS | $3,893 |
| BLUE CROSS - FL | BCBS TRADITIONAL PHS | $3,893 |
| BLUE CROSS - FL | BCBS TRADITIONAL PHS | $3,893 |
| UNITED HEALTHCARE | UNITED HEALTHCARE OPTIONS PPO | $5,146 |
| UNITED HEALTHCARE | UNITED HEALTHCARE OPTIONS PPO | $5,146 |
| UNITED HEALTHCARE | UNITED HEALTHCARE OPTIONS PPO | $5,146 |
| UNITED HEALTHCARE | UNITED HEALTHCARE OPTIONS PPO | $5,146 |
| UNITED HEALTHCARE | UNITED HEALTHCARE OPTIONS PPO | $5,146 |
| UNITED HEALTHCARE | UNITED HEALTHCARE OPTIONS PPO | $5,146 |
| UNITED HEALTHCARE | UNITED HEALTHCARE OPTIONS PPO | $5,146 |
| UNITED HEALTHCARE | UNITED HEALTHCARE OPTIONS PPO | $5,146 |
| UNITED HEALTHCARE | UNITED HEALTHCARE OPTIONS PPO | $5,146 |
| UNITED HEALTHCARE | UNITED HEALTHCARE OPTIONS PPO | $5,146 |
Key finding: At Holy Cross Hospital, published 99285 rates range from $103.48 under an AvMed plan to $5,146 under a UnitedHealthcare PPO, about 50x apart.
What to Do With These ER Visit Prices
Quote the level after the visit. The visit level is set once care is finished, so there is nothing to pick in advance. When the bill arrives, find which of the three codes it lists: 99283, 99284 or 99285. Then ask the hospital's billing office for an itemized statement and its cash price for that same code.
Line your bill up against the rows. This page lists 30 hospitals and 90 price rows. Look up your hospital and your code, then compare. For example, Jackson Memorial Hospital shows a cash price of $246 for 99283, while Baptist Hospital of Miami shows $1,892.80 for 99285. Cash is not always the lower number: 12 rows have a cash price above every insured rate at that same hospital, and 12 of 30 hospitals publish cash equal to the gross charge, such as HCA Florida Kendall Hospital.
Sort the bills by who sent them. The figures here are hospital facility charges only. The ER physician often bills separately, and other clinicians may too. Check these on the bill:
- Whether the level charged matches the care you received
- Whether tests, imaging and medication appear as separate lines
- Whether the facility bill and the physician bill are two different documents
Treat blanks as missing, not free. 3 rows have a gross charge shown as $0 or blank, and 87 of 90 rows publish a cash price. Nicklaus Children's Hospital has no published cash price for any of the three codes. That means the data is missing. Ask the hospital directly for its figure.
Financial assistance and discounts. Nonprofit hospitals are required to publish a financial assistance policy, and the billing office can send it with an application. Some hospitals also offer prompt-pay or self-pay discounts; these vary by hospital and are not included in this data. Assistance applications and discount requests can be made after the visit.
General information about using published prices, not medical, legal or financial advice. Confirm your own cost with the hospital and your insurer. Our methodology · Medical Disclaimer
What Patients Ask About ER Visit Costs
How much does a er visit cost without insurance in Miami-Fort Lauderdale-West Palm Beach?
Cash prices on this page run from $148 at Holy Cross Hospital (99283) to $16,140 at HCA Florida Kendall Hospital (99285). Excluding hospitals where cash equals gross, the range is $148 to $1,892.80 at Baptist Hospital of Miami (99285). Nicklaus Children's Hospital has no published cash price for any of the three codes, which is missing data rather than a $0 price. Cash prices reflect the hospital facility charge only. Professional fees, such as the emergency physician's bill, are billed separately and are not included.
Why is the gross charge so much higher than the cash price?
The gross charge is a hospital's list price and is rarely what a self-pay patient is quoted. On this page, cash is often a set share of gross. Baptist Health South Florida hospitals list cash at 65% of gross, Memorial Healthcare System hospitals at 70%, and Jackson Health System hospitals at 17% to 19%. For example, Jackson Memorial Hospital lists a 99284 gross of $2,317 and a cash price of $387. Some hospitals show no gap at all: 11 of 30 publish cash equal to gross, so cash is 100% of gross there. At Lakeside Medical Center, 99283 cash is 118% of gross.
Does insurance cover a er visit?
Whether insurance covers an ER visit, and how much you pay, depends on your plan, so check the plan's own documents. This page shows insured ranges taken from the hospital files. At Baptist Hospital of Miami, 99285 insured rates run from $173.17 to $2,912, and at Holy Cross Hospital, 99284 rates run from $12.27 to $4,995. If you have a high-deductible plan and have not met your deductible, you usually pay the plan's negotiated rate until it is met. In 7 rows, cash is above every insured rate at that hospital.
Are there additional fees beyond the er visit facility charge?
The facility charge is only one part of an emergency visit. Separate bills commonly come from the emergency physician, and sometimes from radiologists who read imaging, pathologists or labs who process tests, and consulting specialists. Ambulance transport, if used, is billed by the transport provider. Imaging, lab work, procedures, supplies and medications may also be itemized apart from the visit level code, depending on the hospital's billing. Requesting an itemized bill shows which charges are facility fees and which come from other providers.
What is the cash price for a level 5 ER visit at Baptist Hospital of Miami?
Baptist Hospital of Miami lists a cash price of $1,892.80 for the 99285 ER Visit Level 5 (Critical), against a gross charge of $2,912. The cash figure is 65% of gross. These are facility charges only and do not include physician or other separate bills. Insured rates there are shown from $173.17 to $2,912.
Which Miami-area hospitals publish a cash price equal to the gross charge for ER visits?
Twelve of the 30 hospitals on this page publish a cash price equal to gross, meaning no self-pay discount is shown. They include HCA Florida Kendall Hospital, HCA Florida JFK Hospital, Holy Cross Hospital and Mount Sinai Medical Center. For example, HCA Florida Kendall Hospital lists $16,140 for 99285. Figures are facility charges only.
Does Nicklaus Children's Hospital publish a cash price for an ER visit?
No. Nicklaus Children's Hospital has no published cash price or gross charge for 99283, 99284 or 99285 on this page. Those blank values mean the data is missing, not that the visit is free. It does list insured rates, such as $1,497.94 to $1,662.69 for 99283. These are facility charges only.
What is the difference between ER visit codes 99283, 99284 and 99285 in Miami?
The page lists 99283 as ER Visit Level 3 (Moderate), 99284 as Level 4 (High/Urgent) and 99285 as Level 5 (Critical). Prices usually rise with the level. At Jackson Memorial Hospital, cash is $246 for 99283, $387 for 99284 and $555 for 99285. These are facility charges only, not physician fees.
Compare Other Procedures in Miami-Fort Lauderdale-West Palm Beach
Data Sources
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Baptist Hospital of Miami
File updated: 2026-03-30 · Accessed by us: 2026-10-15
Attested by: Sarah Vaupen
We are not affiliated with Baptist Hospital of Miami. Published prices may not reflect your actual cost. Disclaimer
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Bethesda Hospital East
File updated: 2026-03-30 · Accessed by us: 2026-10-15
Attested by: Sarah Vaupen
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Boca Raton Regional Hospital
File updated: 2026-03-30 · Accessed by us: 2026-10-15
Attested by: Sarah Vaupen
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Doctors Hospital
File updated: 2026-03-30 · Accessed by us: 2026-10-15
Attested by: Sarah Vaupen
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Homestead Hospital
File updated: 2026-03-30 · Accessed by us: 2026-10-15
Attested by: Sarah Vaupen
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South Miami Hospital
File updated: 2026-03-30 · Accessed by us: 2026-10-15
Attested by: Sarah Vaupen
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West Kendall Baptist Hospital
File updated: 2026-03-30 · Accessed by us: 2026-10-15
Attested by: Sarah Vaupen
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Cleveland Clinic Weston Hospital
File updated: 2026-06-15 · Accessed by us: 2026-10-15
Attested by: Wes Wolfe
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HCA Florida Aventura Hospital
File updated: 2026-09-01 · Accessed by us: 2026-10-15
Attested by: Richard Hammett
We are not affiliated with HCA Florida Aventura Hospital. Published prices may not reflect your actual cost. Disclaimer
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HCA Florida JFK Hospital
File updated: 2026-09-01 · Accessed by us: 2026-10-15
Attested by: Kenneth West
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HCA Florida JFK North Hospital
File updated: 2026-09-01 · Accessed by us: 2026-10-15
Attested by: Jessica Miller
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HCA Florida Kendall Hospital
File updated: 2026-09-01 · Accessed by us: 2026-10-15
Attested by: Benjamin Harris
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HCA Florida Mercy Hospital
File updated: 2026-09-01 · Accessed by us: 2026-10-15
Attested by: Allyssa Tobitt
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HCA Florida Northwest Hospital
File updated: 2026-09-01 · Accessed by us: 2026-10-15
Attested by: Kenneth Jones
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HCA Florida Palms West Hospital
File updated: 2026-09-01 · Accessed by us: 2026-10-15
Attested by: Cory Mead
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HCA Florida University Hospital
File updated: 2026-09-01 · Accessed by us: 2026-10-15
Attested by: Joseph Gleason
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HCA Florida Westside Hospital
File updated: 2026-09-01 · Accessed by us: 2026-10-15
Attested by: Andrew Tyrer
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HCA Florida Woodmont Hospital
File updated: 2026-09-01 · Accessed by us: 2026-10-15
Attested by: Joseph Britner
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Holy Cross Hospital
File updated: 2026-03-31 · Accessed by us: 2026-10-15
Attested by: Stuart Kilpinen
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Jackson Memorial Hospital
File updated: 2026-10-12 · Accessed by us: 2026-10-15
Attested by: Mark Knight
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Jackson North Medical Center
File updated: 2026-10-13 · Accessed by us: 2026-10-15
Attested by: Mark Knight
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Jackson South Medical Center
File updated: 2026-10-13 · Accessed by us: 2026-10-15
Attested by: Mark Knight
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Jackson West Medical Center
File updated: 2026-10-12 · Accessed by us: 2026-10-15
Attested by: Mark Knight
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Lakeside Medical Center
File updated: 12/2/2025 · Accessed by us: 2026-10-15
Attested by: Jessica Cafarelli, CFO
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Memorial Hospital Miramar
File updated: 2026-05-27 · Accessed by us: 2026-10-15
Attested by: Tina Hodges
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Memorial Hospital Pembroke
File updated: 2026-05-27 · Accessed by us: 2026-10-15
Attested by: Tina Hodges
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Memorial Hospital West
File updated: 2026-05-27 · Accessed by us: 2026-10-15
Attested by: Tina Hodges
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Memorial Regional Hospital
File updated: 2026-05-27 · Accessed by us: 2026-10-15
Attested by: Tina Hodges
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Mount Sinai Medical Center
File updated: 2026-03-13 · Accessed by us: 2026-10-15
Attested by: Gino Santorio
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Nicklaus Children's Hospital
File updated: 2026-04-01 · Accessed by us: 2026-10-15
Attested by: Krista Gerdon
We are not affiliated with Nicklaus Children's Hospital. Published prices may not reflect your actual cost. Disclaimer
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