Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 330.74 274.24 265.64 219.81 661.48 548.48 531.28 439.62 628.41 521.06 504.72 417.64 926.07 767.87 743.79 615.47 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 371.50 312.69 324.55 243.76 780.15 656.65 681.56 511.90 668.70 562.84 584.19 438.77 1,125.64 947.45 983.38 738.59 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 380.44 331.53 286.71 247.69 846.23 737.45 637.73 550.94 722.82 629.90 544.73 470.60 1,108.13 965.67 835.10 721.45 HealthNow New York, Inc. d/b/a BlueShield of NENY 30 Century Hill Drive Latham, NY 12110 Long distance Local 321.24 238.44 260.07 181.07 658.55 488.80 533.15 371.20 654.99 486.16 530.15 369.06 930.09 690.34 752.82 524.07 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 348.13 283.12 273.75 214.88 696.26 566.24 547.50 429.76 678.88 552.10 533.83 419.03 1,000.87 813.97 787.03 617.78 Excellus Health Plan, Inc. d/b/a Univera Healthcare (So. Tier) Individuals/Sole Proprietors: P.O. Box 23000 Rochester, NY 14692 Small Groups: Attn: Sales Department 205 Park Club Lane Buffalo, NY 14221 278.09 186.09 224.98 145.29 548.95 367.34 444.70 286.79 816.67 546.96 660.68 427.04 HealthNow New York, Inc. 1701 North Street Endicott, NY 13760 305.99 224.68 254.62 181.71 627.28 460.60 521.96 372.50 623.90 458.10 519.03 370.37 983.88 722.42 818.52 584.08 Independent Health Association, Inc. Attn: Sales Department 511 Farber Lakes Drive Buffalo, NY 14221 295.75 220.74 222.20 174.21 595.64 444.57 447.51 350.86 521.71 389.39 391.96 307.31 873.35 651.85 656.15 514.44 Aetna Health, Inc. Healthy New York Program 3 Independence Way 4th Floor Princeton, NJ 08540 487.00 430.00 376.00 330.00 974.00 861.00 752.00 660.00 901.00 796.00 696.00 611.00 1,509.00 1,334.00 1,166.00 1,023.00 Atlantis Health Plan, Inc. 45 Broadway Suite 300 New York, NY 10006 366.88 323.42 289.59 251.67 733.75 646.83 579.19 503.35 719.08 633.90 567.60 493.28 1,100.63 970.25 868.78 755.02 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 430.75 360.92 374.61 281.37 904.57 757.93 786.68 590.88 775.35 649.66 674.30 506.47 1,305.17 1,093.59 1,135.07 852.55 GHI Healthy New York EPO * Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 391.93 332.54 282.54 227.74 862.20 731.61 621.56 501.04 744.64 631.83 536.81 432.71 1,156.16 981.01 833.43 671.86 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 467.07 407.03 351.99 304.08 1,038.93 905.36 782.93 676.41 887.42 773.33 668.75 577.76 1,360.46 1,185.55 1,025.24 885.73 HIP Health Plan of New York, Inc. Sole Proprietors/Individuals: P.O. Box 2793 New York, NY 10116 Small Groups: P.O. Box 2806 New York, NY 10116 485.03 401.91 395.06 322.73 970.08 803.80 790.13 645.46 902.17 747.53 734.82 600.27 1,484.21 1,229.81 1,208.90 987.56 Managed Health, Inc. d/b/a HealthFirst New York P.O. Box 5193 New York, NY 10274 365.15 321.32 270.16 243.32 729.92 642.33 540.02 486.39 645.93 568.42 477.87 430.43 1,084.46 954.34 802.32 722.66 Oxford Health Plans, Inc. Individual & Sole Proprietors: 14 Central Park Drive Attn: Personal Plans Hooksett, NH 03106 Small Groups: Oxford Health Plans (NY), Inc. 14 Central Park Drive Hooksett, NH 03106 412.85 345.47 320.28 268.97 908.27 760.03 704.62 591.73 809.19 677.12 627.75 527.18 1,341.76 1,122.78 1,040.91 874.15 Aetna Health, Inc. Healthy New York Program 3 Independence Way 4th Floor Princeton, NJ 08540 487.00 430.00 376.00 330.00 974.00 861.00 752.00 660.00 901.00 796.00 696.00 611.00 1,509.00 1,334.00 1,166.00 1,023.00 Capital District Physicians' Health Plan, Inc. 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 373.38 316.88 299.82 253.99 746.77 633.77 599.64 507.98 709.43 602.08 569.66 482.58 1,045.48 887.28 839.49 711.17 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Central New York Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 367.57 219.08 297.37 171.03 830.71 495.13 672.06 386.55 568.92 339.40 460.27 264.95 1,003.08 598.41 811.53 467.17 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 380.44 331.53 286.71 247.69 846.23 737.45 637.73 550.94 722.82 629.90 544.73 470.60 1,108.13 965.67 835.10 721.45 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 364.25 299.24 289.34 227.11 728.50 598.48 578.68 454.22 710.31 583.54 564.23 442.88 1,047.22 860.32 831.85 652.94 Excellus Health Plan, Inc. d/b/a Univera Healthcare (So. Tier) Individuals/Sole Proprietors: P.O. Box 23000 Rochester, NY 14692 Small Groups: Attn: Sales Department 205 Park Club Lane Buffalo, NY 14221 278.09 186.09 224.98 145.29 548.95 367.34 444.70 286.79 816.67 546.96 660.68 427.04 HealthNow New York, Inc. 1701 North Street Endicott, NY 13760 305.99 224.68 254.62 181.71 627.28 460.60 521.96 372.50 623.90 458.10 519.03 370.37 983.88 722.42 818.52 584.08 Independent Health Association, Inc. Independent Health Attn: Sales Dept. 511 Farber Lakes Drive Buffalo, NY 14221 295.75 220.74 222.20 174.21 595.64 444.57 447.51 350.86 521.71 389.39 391.96 307.31 873.35 651.85 656.15 514.44 Aetna Health, Inc. Healthy New York Program 3 Independence Way 4th Floor Princeton, NJ 08540 487.00 430.00 376.00 330.00 974.00 861.00 752.00 660.00 901.00 796.00 696.00 611.00 1,509.00 1,334.00 1,166.00 1,023.00 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Central New York Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 367.57 219.08 297.37 171.03 830.71 495.13 672.06 386.55 568.92 339.40 460.27 264.95 1,003.08 598.41 811.53 467.17 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 364.25 299.24 289.34 227.11 728.50 598.48 578.68 454.22 710.31 583.54 564.23 442.88 1,047.22 860.32 831.85 652.94 United Healthcare - Healthcore 471.98 394.90 339.71 285.20 1,066.68 892.46 767.75 644.55 741.01 619.98 533.35 447.77 1,297.96 1,085.96 934.20 784.30 Excellus Health Plan, Inc. d/b/a Univera Healthcare (So. Tier) Individuals/Sole Proprietors: P.O. Box 23000 Rochester, NY 14692 Small Groups: Attn: Sales Department 205 Park Club Lane Buffalo, NY 14221 278.09 186.09 224.98 145.29 548.95 367.34 444.70 286.79 816.67 546.96 660.68 427.04 HealthNow New York, Inc. 1701 North Street Endicott, NY 13760 305.99 224.68 254.62 181.71 627.28 460.60 521.96 372.50 623.90 458.10 519.03 370.37 983.88 722.42 818.52 584.08 Independent Health Association, Inc. Independent Health Attn: Sales Dept. 511 Farber Lakes Drive Buffalo, NY 14221 295.75 220.74 222.20 174.21 595.64 444.57 447.51 350.86 521.71 389.39 391.96 307.31 873.35 651.85 656.15 514.44 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Central New York Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 367.57 219.08 297.37 171.03 830.71 495.13 672.06 386.55 568.92 339.40 460.27 264.95 1,003.08 598.41 811.53 467.17 HealthNow New York, Inc. 1701 North Street Endicott, NY 13760 330.13 242.36 283.48 202.17 759.31 557.43 652.00 464.99 723.61 531.22 621.22 443.01 922.18 676.99 791.70 564.56 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 373.38 316.88 299.82 253.99 746.77 633.77 599.64 507.98 709.43 602.08 569.66 482.58 1,045.48 887.28 839.49 711.17 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Utica/Watertown Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 341.86 222.60 276.56 173.72 683.70 445.21 553.14 347.42 678.78 442.41 549.15 345.24 936.39 610.30 757.56 476.24 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 364.25 299.24 289.34 227.11 728.50 598.48 578.68 454.22 710.31 583.54 564.23 442.88 1,047.22 860.32 831.85 652.94 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 371.50 312.69 324.55 243.76 780.15 656.65 681.56 511.90 668.70 562.84 584.19 438.77 1,125.64 947.45 983.38 738.59 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Utica/Watertown Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 341.86 222.60 276.56 173.72 683.70 445.21 553.14 347.42 678.78 442.41 549.15 345.24 936.39 610.30 757.56 476.24 HealthNow New York, Inc. d/b/a BlueShield of NENY 30 Century Hill Drive Latham, NY 12110 Long distance Local 321.24 238.44 260.07 181.07 658.55 488.80 533.15 371.20 654.99 486.16 530.15 369.06 930.09 690.34 752.82 524.07 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 387.99 322.98 312.29 245.13 775.98 645.96 624.58 490.26 756.61 629.83 608.99 478.02 1,115.47 928.57 897.83 704.75 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 330.74 274.24 265.64 219.81 661.48 548.48 531.28 439.62 628.41 521.06 504.72 417.64 926.07 767.87 743.79 615.47 Empire HealthChoice, Inc. Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 371.50 312.69 324.55 243.76 780.15 656.65 681.56 511.90 668.70 562.84 584.19 438.77 1,125.64 947.45 983.38 738.59 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 380.44 331.53 286.71 247.69 846.23 737.45 637.73 550.94 722.82 629.90 544.73 470.60 1,108.13 965.67 835.10 721.45 HealthNow New York, Inc. d/b/a BlueShield of NENY 30 Century Hill Drive Latham, NY 12110 Long distance Local 321.24 238.44 260.07 181.07 658.55 488.80 533.15 371.20 654.99 486.16 530.15 369.06 930.09 690.34 752.82 524.07 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 348.13 283.12 273.75 214.88 696.26 566.24 547.50 429.76 678.88 552.10 533.83 419.03 1,000.87 813.97 787.03 617.78 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Central New York Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 367.57 219.08 297.37 171.03 830.71 495.13 672.06 386.55 568.92 339.40 460.27 264.95 1,003.08 598.41 811.53 467.17 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 364.25 299.24 289.34 227.11 728.50 598.48 578.68 454.22 710.31 583.54 564.23 442.88 1,047.22 860.32 831.85 652.94 United Healthcare - Healthcore 471.98 394.90 339.71 285.20 1,066.68 892.46 767.75 644.55 741.01 619.98 533.35 447.77 1,297.96 1,085.96 934.20 784.30 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 373.38 316.88 299.82 253.99 746.77 633.77 599.64 507.98 709.43 602.08 569.66 482.58 1,045.48 887.28 839.49 711.17 Empire HealthChoice, Inc. Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 371.50 312.69 324.55 243.76 780.15 656.65 681.56 511.90 668.70 562.84 584.19 438.77 1,125.64 947.45 983.38 738.59 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Utica/Watertown Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 341.86 222.60 276.56 173.72 683.70 445.21 553.14 347.42 678.78 442.41 549.15 345.24 936.39 610.30 757.56 476.24 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 380.44 331.53 286.71 247.69 846.23 737.45 637.73 550.94 722.82 629.90 544.73 470.60 1,108.13 965.67 835.10 721.45 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 364.25 299.24 289.34 227.11 728.50 598.48 578.68 454.22 710.31 583.54 564.23 442.88 1,047.22 860.32 831.85 652.94 Aetna Health, Inc. Healthy New York Program 3 Independence Way 4th Floor Princeton, NJ 08540 Option 1: Ind./Sole Prop. Option 2: Sm. Group 487.00 430.00 376.00 330.00 974.00 861.00 752.00 660.00 901.00 796.00 696.00 611.00 1,509.00 1,334.00 1,166.00 1,023.00 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 378.51 322.01 303.93 258.10 757.02 644.02 607.86 516.20 719.17 611.82 577.47 490.39 1,059.83 901.63 851.00 722.68 Empire HealthChoice, Inc. Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 406.74 340.82 353.74 265.67 854.15 715.72 742.86 557.91 732.14 613.48 636.74 478.21 1,232.42 1,032.68 1,071.83 804.98 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 417.23 363.58 314.42 271.64 928.07 808.74 699.38 604.22 792.72 690.79 597.38 516.10 1,215.29 1,059.04 915.83 791.21 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 370.40 305.39 295.29 231.78 740.80 610.78 590.58 463.56 722.30 595.53 575.83 451.99 1,064.90 878.00 848.96 666.37 Oxford Health Plans, Inc. Individual & Sole Proprietors: 14 Central Park Drive Attn: Personal Plans Hooksett, NH 03106 Small Groups: Oxford Health Plans (NY), Inc. 14 Central Park Drive Hooksett, NH 03106 412.85 345.47 320.28 268.97 908.27 760.03 704.62 591.73 809.19 677.12 627.75 527.18 1,341.76 1,122.78 1,040.91 874.15 Excellus Health Plan, Inc. d/b/a Univera Healthcare (WNY) Individuals/Sole Proprietors: P.O. Box 23000 Rochester, NY 14692 Small Groups: Attn: Sales Department 205 Park Club Lane Buffalo, NY 14221 278.09 186.09 224.98 145.29 583.99 390.78 472.44 305.10 509.72 341.37 412.35 266.53 849.51 568.95 687.26 444.21 HealthNow New York, Inc. 1701 North Street Endicott, NY 13760 305.99 224.68 254.62 181.71 627.28 460.60 521.96 372.50 623.90 458.10 519.03 370.37 983.88 722.42 818.52 584.08 Independent Health Association, Inc. Independent Health Attn: Sales Dept. 511 Farber Lakes Drive Buffalo, NY 14221 295.75 220.74 222.20 174.21 595.64 444.57 447.51 350.86 521.71 389.39 391.96 307.31 873.35 651.85 656.15 514.44 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 373.38 316.88 299.82 253.99 746.77 633.77 599.64 507.98 709.43 602.08 569.66 482.58 1,045.48 887.28 839.49 711.17 Empire HealthChoice, Inc. Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 371.50 312.69 324.55 243.76 780.15 656.65 681.56 511.90 668.70 562.84 584.19 438.77 1,125.64 947.45 983.38 738.59 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Utica/Watertown Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 341.86 222.60 276.56 173.72 683.70 445.21 553.14 347.42 678.78 442.41 549.15 345.24 936.39 610.30 757.56 476.24 HealthNow New York, Inc. d/b/a BlueShield of NENY 30 Century Hill Drive Latham, NY 12110 Long distance Local 321.24 238.44 260.07 181.07 658.55 488.80 533.15 371.20 654.99 486.16 530.15 369.06 930.09 690.34 752.82 524.07 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 387.99 322.98 312.29 245.13 775.98 645.96 624.58 490.26 756.61 629.83 608.99 478.02 1,115.47 928.57 897.83 704.75 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Utica/Watertown Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 341.86 222.60 276.56 173.72 683.70 445.21 553.14 347.42 678.78 442.41 549.15 345.24 936.39 610.30 757.56 476.24 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 387.99 322.98 312.29 245.13 775.98 645.96 624.58 490.26 756.61 629.83 608.99 478.02 1,115.47 928.57 897.83 704.75 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 330.74 274.24 265.64 219.81 661.48 548.48 531.28 439.62 628.41 521.06 504.72 417.64 926.07 767.87 743.79 615.47 Empire HealthChoice, Inc. Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 371.50 312.69 324.55 243.76 780.15 656.65 681.56 511.90 668.70 562.84 584.19 438.77 1,125.64 947.45 983.38 738.59 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Utica/Watertown Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 341.86 222.60 276.56 173.72 683.70 445.21 553.14 347.42 678.78 442.41 549.15 345.24 936.39 610.30 757.56 476.24 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 380.44 331.53 286.71 247.69 846.23 737.45 637.73 550.94 722.82 629.90 544.73 470.60 1,108.13 965.67 835.10 721.45 HealthNow New York, Inc. d/b/a BlueShield of NENY 30 Century Hill Drive Latham, NY 12110 Long distance Local 321.24 238.44 260.07 181.07 658.55 488.80 533.15 371.20 654.99 486.16 530.15 369.06 930.09 690.34 752.82 524.07 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 348.13 283.12 273.75 214.88 696.26 566.24 547.50 429.76 678.88 552.10 533.83 419.03 1,000.87 813.97 787.03 617.78 Excellus Health Plan, Inc. d/b/a Univera Healthcare (WNY) Individuals/Sole Proprietors: P.O. Box 23000 Rochester, NY 14692 Small Groups: Attn: Sales Department 205 Park Club Lane Buffalo, NY 14221 278.09 233.96 224.98 182.63 583.99 491.31 472.44 383.53 509.72 429.20 412.35 335.05 849.51 715.32 687.26 558.40 HealthNow New York, Inc. 1701 North Street Endicott, NY 13760 305.99 224.68 254.62 181.71 627.28 460.60 521.96 372.50 623.90 458.10 519.03 370.37 983.88 722.42 818.52 584.08 Independent Health Association, Inc. Independent Health Attn: Sales Dept. 511 Farber Lakes Drive Buffalo, NY 14221 295.75 220.74 222.20 174.21 595.64 444.57 447.51 350.86 521.71 389.39 391.96 307.31 873.35 651.85 656.15 514.44 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 305.34 240.33 232.38 182.40 610.68 480.66 464.76 364.80 595.43 468.66 453.16 355.69 877.85 690.95 668.09 524.40 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 330.74 274.24 265.64 219.81 661.48 548.48 531.28 439.62 628.41 521.06 504.72 417.64 926.07 767.87 743.79 615.47 Empire HealthChoice, Inc. Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 371.50 312.69 324.55 243.76 780.15 656.65 681.56 511.90 668.70 562.84 584.19 438.77 1,125.64 947.45 983.38 738.59 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 380.44 331.53 286.71 247.69 846.23 737.45 637.73 550.94 722.82 629.90 544.73 470.60 1,108.13 965.67 835.10 721.45 HealthNow New York, Inc. d/b/a BlueShield of NENY 30 Century Hill Drive Latham, NY 12110 Long distance Local 321.24 238.44 260.07 181.07 658.55 488.80 533.15 371.20 654.99 486.16 530.15 369.06 930.09 690.34 752.82 524.07 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 348.13 283.12 273.75 214.88 696.26 566.24 547.50 429.76 678.88 552.10 533.83 419.03 1,000.87 813.97 787.03 617.78 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 373.38 316.88 299.82 253.99 746.77 633.77 599.64 507.98 709.43 602.08 569.66 482.58 1,045.48 887.28 839.49 711.17 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Utica/Watertown Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 341.86 222.60 276.56 173.72 683.70 445.21 553.14 347.42 678.78 442.41 549.15 345.24 936.39 610.30 757.56 476.24 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 348.13 283.12 273.75 214.88 696.26 566.24 547.50 429.76 678.88 552.10 533.83 419.03 1,000.87 813.97 787.03 617.78 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 373.38 316.88 299.82 253.99 746.77 633.77 599.64 507.98 709.43 602.08 569.66 482.58 1,045.48 887.28 839.49 711.17 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Utica/Watertown Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 341.86 222.60 276.56 173.72 683.70 445.21 553.14 347.42 678.78 442.41 549.15 345.24 936.39 610.30 757.56 476.24 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 364.25 299.24 289.34 227.11 728.50 598.48 578.68 454.22 710.31 583.54 564.23 442.88 1,047.22 860.32 831.85 652.94 United Healthcare - Healthcore 471.98 394.90 339.71 285.20 1,066.68 892.46 767.75 644.55 741.01 619.98 533.35 447.77 1,297.96 1,085.96 934.20 784.30 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Utica/Watertown Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 341.86 222.60 276.56 173.72 683.70 445.21 553.14 347.42 678.78 442.41 549.15 345.24 936.39 610.30 757.56 476.24 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 364.25 299.24 289.34 227.11 728.50 598.48 578.68 454.22 710.31 583.54 564.23 442.88 1,047.22 860.32 831.85 652.94 United Healthcare - Healthcore 471.98 394.90 339.71 285.20 1,066.68 892.46 767.75 644.55 741.01 619.98 533.35 447.77 1,297.96 1,085.96 934.20 784.30 Aetna Health, Inc. Healthy New York Program 3 Independence Way 4th Floor Princeton, NJ 08540 487.00 430.00 376.00 330.00 974.00 861.00 752.00 660.00 901.00 796.00 696.00 611.00 1,509.00 1,334.00 1,166.00 1,023.00 Atlantis Health Plan, Inc. 45 Broadway Suite 300 New York, NY 10006 366.88 323.42 289.59 251.67 733.75 646.83 579.19 503.35 719.08 633.90 567.60 493.28 1,100.63 970.25 868.78 755.02 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 430.75 360.92 374.61 281.37 904.57 757.93 786.68 590.88 775.35 649.66 674.30 506.47 1,305.17 1,093.59 1,135.07 852.55 GHI Healthy New York EPO * Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 391.93 332.54 282.54 227.74 862.20 731.61 621.56 501.04 744.64 631.83 536.81 432.71 1,156.16 981.01 833.43 671.86 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 467.07 407.03 351.99 304.08 1,038.93 905.36 782.93 676.41 887.42 773.33 668.75 577.76 1,360.46 1,185.55 1,025.24 885.73 GHI - Brooklyn HealthWorks HIP Health Plan of New York, Inc. Customer Service 55 Water Street New York, NY 10041-8190 485.03 401.91 395.06 322.73 970.08 803.80 790.13 645.46 902.17 747.53 734.82 600.27 1,484.21 1,229.81 1,208.90 987.56 Managed Health, Inc. d/b/a HealthFirst New York P.O. Box 5193 New York, NY 10274 365.15 321.32 270.16 243.32 729.92 642.33 540.02 486.39 645.93 568.42 477.87 430.43 1,084.46 954.34 802.32 722.66 Oxford Health Plans, Inc. Individual & Sole Proprietors: 14 Central Park Drive Attn: Personal Plans Hooksett, NH 03106 Small Groups: Oxford Health Plans (NY), Inc. 14 Central Park Drive Hooksett, NH 03106 412.85 345.47 320.28 268.97 908.27 760.03 704.62 591.73 809.19 677.12 627.75 527.18 1,341.76 1,122.78 1,040.91 874.15 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Utica/Watertown Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 341.86 222.60 276.56 173.72 683.70 445.21 553.14 347.42 678.78 442.41 549.15 345.24 936.39 610.30 757.56 476.24 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 364.25 299.24 289.34 227.11 728.50 598.48 578.68 454.22 710.31 583.54 564.23 442.88 1,047.22 860.32 831.85 652.94 United Healthcare - Healthcore 471.98 394.90 339.71 285.20 1,066.68 892.46 767.75 644.55 741.01 619.98 533.35 447.77 1,297.96 1,085.96 934.20 784.30 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Rochester Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 282.56 186.82 228.61 145.87 696.69 460.62 563.76 359.71 578.35 382.72 467.90 298.80 761.48 503.91 616.19 393.50 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 305.34 240.33 232.38 182.40 610.68 480.66 464.76 364.80 595.43 468.66 453.16 355.69 877.85 690.95 668.09 524.40 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 373.38 316.88 299.82 253.99 746.77 633.77 599.64 507.98 709.43 602.08 569.66 482.58 1,045.48 887.28 839.49 711.17 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Utica/Watertown Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 341.86 222.60 276.56 173.72 683.70 445.21 553.14 347.42 678.78 442.41 549.15 345.24 936.39 610.30 757.56 476.24 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 364.25 299.24 289.34 227.11 728.50 598.48 578.68 454.22 710.31 583.54 564.23 442.88 1,047.22 860.32 831.85 652.94 United Healthcare - Healthcore 471.98 394.90 339.71 285.20 1,066.68 892.46 767.75 644.55 741.01 619.98 533.35 447.77 1,297.96 1,085.96 934.20 784.30 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Rochester Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 282.56 186.82 228.61 145.87 696.69 460.62 563.76 359.71 578.35 382.72 467.90 298.80 761.48 503.91 616.19 393.50 HealthNow New York, Inc. 1701 North Street Endicott, NY 13760 Long distance Local 329.96 242.19 283.33 202.01 758.92 557.04 651.66 464.62 723.24 530.84 620.91 442.65 921.70 676.51 791.29 564.12 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 305.34 240.33 232.38 182.40 610.68 480.66 464.76 364.80 595.43 468.66 453.16 355.69 877.85 690.95 668.09 524.40 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 330.74 274.24 265.64 219.81 661.48 548.48 531.28 439.62 628.41 521.06 504.72 417.64 926.07 767.87 743.79 615.47 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 371.50 312.69 324.55 243.76 780.15 656.65 681.56 511.90 668.70 562.84 584.19 438.77 1,125.64 947.45 983.38 738.59 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Utica/Watertown Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 341.86 222.60 276.56 173.72 683.70 445.21 553.14 347.42 678.78 442.41 549.15 345.24 936.39 610.30 757.56 476.24 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 380.44 331.53 286.71 247.69 846.23 737.45 637.73 550.94 722.82 629.90 544.73 470.60 1,108.13 965.67 835.10 721.45 HealthNow New York, Inc. d/b/a BlueShield of NENY 30 Century Hill Drive Latham, NY 12110 Long distance Local 321.24 238.44 260.07 181.07 658.55 488.80 533.15 371.20 654.99 486.16 530.15 369.06 930.09 690.34 752.82 524.07 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 348.13 283.12 273.75 214.88 696.26 566.24 547.50 429.76 678.88 552.10 533.83 419.03 1,000.87 813.97 787.03 617.78 Aetna Health, Inc. Healthy New York Program 3 Independence Way 4th Floor Princeton, NJ 08540 487.00 430.00 376.00 330.00 974.00 861.00 752.00 660.00 901.00 796.00 696.00 611.00 1,509.00 1,334.00 1,166.00 1,023.00 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 430.75 360.92 374.61 281.37 904.57 757.93 786.68 590.88 775.35 649.66 674.30 506.47 1,305.17 1,093.59 1,135.07 852.55 GHI Healthy New York EPO * Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 391.93 332.54 282.54 227.74 862.20 731.61 621.56 501.04 744.64 631.83 536.81 432.71 1,156.16 981.01 833.43 671.86 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 467.07 407.03 351.99 304.08 1,038.93 905.36 782.93 676.41 887.42 773.33 668.75 577.76 1,360.46 1,185.55 1,025.24 885.73 HIP Health Plan of New York, Inc. Sole Proprietors/Individuals: P.O. Box 2793 New York, NY 10116 Small Groups: P.O. Box 2806 New York, NY 10116 485.03 401.91 395.06 322.73 970.08 803.80 790.13 645.46 902.17 747.53 734.82 600.27 1,484.21 1,229.81 1,208.90 987.56 Managed Health, Inc. d/b/a HealthFirst New York P.O. Box 5193 New York, NY 10274 365.15 321.32 270.16 243.32 729.92 642.33 540.02 486.39 645.93 568.42 477.87 430.43 1,084.46 954.34 802.32 722.66 Oxford Health Plans, Inc. Individual & Sole Proprietors: 14 Central Park Drive Attn: Personal Plans Hooksett, NH 03106 Small Groups: Oxford Health Plans (NY), Inc. 14 Central Park Drive Hooksett, NH 03106 412.85 345.47 320.28 268.97 908.27 760.03 704.62 591.73 809.19 677.12 627.75 527.18 1,341.76 1,122.78 1,040.91 874.15 Aetna Health, Inc. Healthy New York Program 3 Independence Way 4th Floor Princeton, NJ 08540 487.00 430.00 376.00 330.00 974.00 861.00 752.00 660.00 901.00 796.00 696.00 611.00 1,509.00 1,334.00 1,166.00 1,023.00 Atlantis Health Plan, Inc. 45 Broadway Suite 300 New York, NY 10006 366.88 323.42 289.59 251.67 733.75 646.83 579.19 503.35 719.08 633.90 567.60 493.28 1,100.63 970.25 868.78 755.02 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 430.75 360.92 374.61 281.37 904.57 757.93 786.68 590.88 775.35 649.66 674.30 506.47 1,305.17 1,093.59 1,135.07 852.55 GHI Healthy New York EPO * Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 391.93 332.54 282.54 227.74 862.20 731.61 621.56 501.04 744.64 631.83 536.81 432.71 1,156.16 981.01 833.43 671.86 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 467.07 407.03 351.99 304.08 1,038.93 905.36 782.93 676.41 887.42 773.33 668.75 577.76 1,360.46 1,185.55 1,025.24 885.73 HIP Health Plan of New York, Inc. Sole Proprietors/Individuals: P.O. Box 2793 New York, NY 10116 Small Groups: P.O. Box 2806 New York, NY 10116 485.03 401.91 395.06 322.73 970.08 803.80 790.13 645.46 902.17 747.53 734.82 600.27 1,484.21 1,229.81 1,208.90 987.56 Managed Health, Inc. d/b/a HealthFirst New York P.O. Box 5193 New York, NY 10274 365.15 321.32 270.16 243.32 729.92 642.33 540.02 486.39 645.93 568.42 477.87 430.43 1,084.46 954.34 802.32 722.66 Oxford Health Plans, Inc. Individual & Sole Proprietors: 14 Central Park Drive Attn: Personal Plans Hooksett, NH 03106 Small Groups: Oxford Health Plans (NY), Inc. 14 Central Park Drive Hooksett, NH 03106 412.85 345.47 320.28 268.97 908.27 760.03 704.62 591.73 809.19 677.12 627.75 527.18 1,341.76 1,122.78 1,040.91 874.15 Excellus Health Plan, Inc. d/b/a Univera Healthcare (WNY) Individuals/Sole Proprietors: P.O. Box 23000 Rochester, NY 14692 Small Groups: Attn: Sales Department 205 Park Club Lane Buffalo, NY 14221 278.09 186.09 224.98 145.29 583.99 390.78 472.44 305.10 509.72 341.37 412.35 266.53 849.51 568.95 687.26 444.21 HealthNow New York, Inc. 1701 North Street Endicott, NY 13760 305.99 224.68 254.62 181.71 627.28 460.60 521.96 372.50 623.90 458.10 519.03 370.37 983.88 722.42 818.52 584.08 Independent Health Association, Inc. Independent Health Attn: Sales Dept. 511 Farber Lakes Drive Buffalo, NY 14221 295.75 220.74 222.20 174.21 595.64 444.57 447.51 350.86 521.71 389.39 391.96 307.31 873.35 651.85 656.15 514.44 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 373.38 316.88 299.82 253.99 746.77 633.77 599.64 507.98 709.43 602.08 569.66 482.58 1,045.48 887.28 839.49 711.17 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Utica/Watertown Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 341.86 222.60 276.56 173.72 683.70 445.21 553.14 347.42 678.78 442.41 549.15 345.24 936.39 610.30 757.56 476.24 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 364.25 299.24 289.34 227.11 728.50 598.48 578.68 454.22 710.31 583.54 564.23 442.88 1,047.22 860.32 831.85 652.94 United Healthcare - Healthcore 471.98 394.90 339.71 285.20 1,066.68 892.46 767.75 644.55 741.01 619.98 533.35 447.77 1,297.96 1,085.96 934.20 784.30 Aetna Health, Inc. Healthy New York Program 3 Independence Way 4th Floor Princeton, NJ 08540 487.00 430.00 376.00 330.00 974.00 861.00 752.00 660.00 901.00 796.00 696.00 611.00 1,509.00 1,334.00 1,166.00 1,023.00 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Central New York Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 367.57 219.08 297.37 171.03 830.71 495.13 672.06 386.55 568.92 339.40 460.27 264.95 1,003.08 598.41 811.53 467.17 HealthNow New York, Inc. 30 Century Hill Drive Latham, NY 12110 Long distance Local 408.48 316.64 337.43 244.77 837.37 649.11 691.74 501.78 832.88 645.62 687.90 498.96 1,182.69 916.78 976.82 708.52 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 364.25 299.24 289.34 227.11 728.50 598.48 578.68 454.22 710.31 583.54 564.23 442.88 1,047.22 860.32 831.85 652.94 United Healthcare - Healthcore 471.98 394.90 339.71 285.20 1,066.68 892.46 767.75 644.55 741.01 619.98 533.35 447.77 1,297.96 1,085.96 934.20 784.30 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Rochester Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 282.56 186.82 228.61 145.87 696.69 460.62 563.76 359.71 578.35 382.72 467.90 298.80 761.48 503.91 616.19 393.50 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 305.34 240.33 232.38 182.40 610.68 480.66 464.76 364.80 595.43 468.66 453.16 355.69 877.85 690.95 668.09 524.40 Aetna Health, Inc. Healthy New York Program 3 Independence Way 4th Floor Princeton, NJ 08540 487.00 430.00 376.00 330.00 974.00 861.00 752.00 660.00 901.00 796.00 696.00 611.00 1,509.00 1,334.00 1,166.00 1,023.00 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 390.50 334.00 313.54 267.71 781.00 668.00 627.08 535.42 741.95 634.60 595.73 508.65 1,093.40 935.20 877.91 749.59 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 406.74 340.82 353.74 265.67 854.15 715.72 742.86 557.91 732.14 613.48 636.74 478.21 1,232.42 1,032.68 1,071.83 804.98 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 417.23 363.58 314.42 271.64 928.07 808.74 699.38 604.22 792.72 690.79 597.38 516.10 1,215.29 1,059.04 915.83 791.21 HIP Health Plan of New York, Inc. Sole Proprietors/Individuals P.O. Box 2793 New York, NY 10116 Small Groups: P.O. Box 2806 New York, NY 10116 485.03 401.91 395.06 322.73 970.08 803.80 790.13 645.46 902.17 747.53 734.82 600.27 1,484.21 1,229.81 1,208.90 987.56 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 370.40 305.39 295.29 231.78 740.80 610.78 590.58 463.56 722.30 595.53 575.83 451.99 1,064.90 878.00 848.96 666.37 Oxford Health Plans, Inc. Individual & Sole Proprietors: 14 Central Park Drive Attn: Personal Plans Hooksett, NH 03106 Small Groups: Oxford Health Plans (NY), Inc. 14 Central Park Drive Hooksett, NH 03106 412.85 345.47 320.28 268.97 908.27 760.03 704.62 591.73 809.19 677.12 627.75 527.18 1,341.76 1,122.78 1,040.91 874.15 Excellus Health Plan, Inc. d/b/a Univera Healthcare (WNY) Individuals/Sole Proprietors: P.O. Box 23000 Rochester, NY 14692 Small Groups: Attn: Sales Department 205 Park Club Lane Buffalo, NY 14221 278.09 186.09 224.98 145.29 583.99 390.78 472.44 305.10 509.72 341.37 412.35 266.53 849.51 568.95 687.26 444.21 HealthNow New York, Inc. 1701 North Street Endicott, NY 13760 305.99 224.68 254.62 181.71 627.28 460.60 521.96 372.50 623.90 458.10 519.03 370.37 983.88 722.42 818.52 584.08 Independent Health Association, Inc. Independent Health Attn: Sales Dept. 511 Farber Lakes Drive Buffalo, NY 14221 295.75 220.74 222.20 174.21 595.64 444.57 447.51 350.86 521.71 389.39 391.96 307.31 873.35 651.85 656.15 514.44 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 305.34 240.33 232.38 182.40 610.68 480.66 464.76 364.80 595.43 468.66 453.16 355.69 877.85 690.95 668.09 524.40 Aetna Health, Inc. Healthy New York Program 3 Independence Way 4th Floor Princeton, NJ 08540 487.00 430.00 376.00 330.00 974.00 861.00 752.00 660.00 901.00 796.00 696.00 611.00 1,509.00 1,334.00 1,166.00 1,023.00 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Central New York Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 367.57 219.08 297.37 171.03 830.71 495.13 672.06 386.55 568.92 339.40 460.27 264.95 1,003.08 598.41 811.53 467.17 HealthNow New York, Inc. 30 Century Hill Drive Latham, NY 12110 Long distance Local 408.48 316.64 337.43 244.77 837.37 649.11 691.74 501.78 832.88 645.62 687.90 498.96 1,182.69 916.78 976.82 708.52 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 364.25 299.24 289.34 227.11 728.50 598.48 578.68 454.22 710.31 583.54 564.23 442.88 1,047.22 860.32 831.85 652.94 United Healthcare - Healthcore 471.98 394.90 339.71 285.20 1,066.68 892.46 767.75 644.55 741.01 619.98 533.35 447.77 1,297.96 1,085.96 934.20 784.30 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 373.38 316.88 299.82 253.99 746.77 633.77 599.64 507.98 709.43 602.08 569.66 482.58 1,045.48 887.28 839.49 711.17 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Utica/Watertown Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 341.86 222.60 276.56 173.72 683.70 445.21 553.14 347.42 678.78 442.41 549.15 345.24 936.39 610.30 757.56 476.24 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 380.44 331.53 286.71 247.69 846.23 737.45 637.73 550.94 722.82 629.90 544.73 470.60 1,108.13 965.67 835.10 721.45 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 364.25 299.24 289.34 227.11 728.50 598.48 578.68 454.22 710.31 583.54 564.23 442.88 1,047.22 860.32 831.85 652.94 Aetna Health, Inc. Healthy New York Program 3 Independence Way 4th Floor Princeton, NJ 08540 487.00 430.00 376.00 330.00 974.00 861.00 752.00 660.00 901.00 796.00 696.00 611.00 1,509.00 1,334.00 1,166.00 1,023.00 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 406.74 340.82 353.74 265.67 854.15 715.72 742.86 557.91 732.14 613.48 636.74 478.21 1,232.42 1,032.68 1,071.83 804.98 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 417.23 363.58 314.42 271.64 928.07 808.74 699.38 604.22 792.72 690.79 597.38 516.10 1,215.29 1,059.04 915.83 791.21 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 370.40 305.39 295.29 231.78 740.80 610.78 590.58 463.56 722.30 595.53 575.83 451.99 1,064.90 878.00 848.96 666.37 Oxford Health Plans, Inc. Individual & Sole Proprietors: 14 Central Park Drive Attn: Personal Plans Hooksett, NH 03106 Small Groups: Oxford Health Plans (NY), Inc. 14 Central Park Drive Hooksett, NH 03106 412.85 345.47 320.28 268.97 908.27 760.03 704.62 591.73 809.19 677.12 627.75 527.18 1,341.76 1,122.78 1,040.91 874.15 Aetna Health, Inc. Healthy New York Program 3 Independence Way 4th Floor Princeton, NJ 08540 487.00 430.00 376.00 330.00 974.00 861.00 752.00 660.00 901.00 796.00 696.00 611.00 1,509.00 1,334.00 1,166.00 1,023.00 Atlantis Health Plan, Inc. 45 Broadway Suite 300 New York, NY 10006 366.88 323.42 289.59 251.67 733.75 646.83 579.19 503.35 719.08 633.90 567.60 493.28 1,100.63 970.25 868.78 755.02 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 430.75 360.92 374.61 281.37 904.57 757.93 786.68 590.88 775.35 649.66 674.30 506.47 1,305.17 1,093.59 1,135.07 852.55 GHI Healthy New York EPO * Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 391.93 332.54 282.54 227.74 862.20 731.61 621.56 501.04 744.64 631.83 536.81 432.71 1,156.16 981.01 833.43 671.86 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 467.07 407.03 351.99 304.08 1,038.93 905.36 782.93 676.41 887.42 773.33 668.75 577.76 1,360.46 1,185.55 1,025.24 885.73 HIP Health Plan of New York, Inc. Sole Proprietors/Individuals: P.O. Box 2793 New York, NY 10116 Small Groups: P.O. Box 2806 New York, NY 10116 485.03 401.91 395.06 322.73 970.08 803.80 790.13 645.46 902.17 747.53 734.82 600.27 1,484.21 1,229.81 1,208.90 987.56 Managed Health, Inc. d/b/a HealthFirst New York P.O. Box 5193 New York, NY 10274 365.15 321.32 270.16 243.32 729.92 642.33 540.02 486.39 645.93 568.42 477.87 430.43 1,084.46 954.34 802.32 722.66 Oxford Health Plans, Inc. Individual & Sole Proprietors: 14 Central Park Drive Attn: Personal Plans Hooksett, NH 03106 Small Groups: Oxford Health Plans (NY), Inc. 14 Central Park Drive Hooksett, NH 03106 412.85 345.47 320.28 268.97 908.27 760.03 704.62 591.73 809.19 677.12 627.75 527.18 1,341.76 1,122.78 1,040.91 874.15 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 330.74 274.24 265.64 219.81 661.48 548.48 531.28 439.62 628.41 521.06 504.72 417.64 926.07 767.87 743.79 615.47 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 371.50 312.69 324.55 243.76 780.15 656.65 681.56 511.90 668.70 562.84 584.19 438.77 1,125.64 947.45 983.38 738.59 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 380.44 331.53 286.71 247.69 846.23 737.45 637.73 550.94 722.82 629.90 544.73 470.60 1,108.13 965.67 835.10 721.45 HealthNow New York, Inc. d/b/a BlueShield of NENY 30 Century Hill Drive Latham, NY 12110 Long distance Local 321.24 238.44 260.07 181.07 658.55 488.80 533.15 371.20 654.99 486.16 530.15 369.06 930.09 690.34 752.82 524.07 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 348.13 283.12 273.75 214.88 696.26 566.24 547.50 429.76 678.88 552.10 533.83 419.03 1,000.87 813.97 787.03 617.78 Aetna Health, Inc. Healthy New York Program 3 Independence Way 4th Floor Princeton, NJ 08540 487.00 430.00 376.00 330.00 974.00 861.00 752.00 660.00 901.00 796.00 696.00 611.00 1,509.00 1,334.00 1,166.00 1,023.00 Atlantis Health Plan, Inc. 45 Broadway Suite 300 New York, NY 10006 366.88 323.42 289.59 251.67 733.75 646.83 579.19 503.35 719.08 633.90 567.60 493.28 1,100.63 970.25 868.78 755.02 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 430.75 360.92 374.61 281.37 904.57 757.93 786.68 590.88 775.35 649.66 674.30 506.47 1,305.17 1,093.59 1,135.07 852.55 GHI Healthy New York EPO * Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 391.93 332.54 282.54 227.74 862.20 731.61 621.56 501.04 744.64 631.83 536.81 432.71 1,156.16 981.01 833.43 671.86 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 467.07 407.03 351.99 304.08 1,038.93 905.36 782.93 676.41 887.42 773.33 668.75 577.76 1,360.46 1,185.55 1,025.24 885.73 HIP Health Plan of New York, Inc. Sole Proprietors/Individuals: P.O. Box 2793 New York, NY 10116 Small Groups: P.O. Box 2806 New York, NY 10116 485.03 401.91 395.06 322.73 970.08 803.80 790.13 645.46 902.17 747.53 734.82 600.27 1,484.21 1,229.81 1,208.90 987.56 Managed Health, Inc. d/b/a HealthFirst New York P.O. Box 5193 New York, NY 10274 365.15 321.32 270.16 243.32 729.92 642.33 540.02 486.39 645.93 568.42 477.87 430.43 1,084.46 954.34 802.32 722.66 Oxford Health Plans, Inc. Individual & Sole Proprietors: 14 Central Park Drive Attn: Personal Plans Hooksett, NH 03106 Sole Proprietor/ Small Groups: Oxford Health Plans (NY), Inc. 14 Central Park Drive Hooksett, NH 03106 412.85 345.47 320.28 268.97 908.27 760.03 704.62 591.73 809.19 677.12 627.75 527.18 1,341.76 1,122.78 1,040.91 874.15 Aetna Health, Inc. Healthy New York Program 3 Independence Way 4th Floor Princeton, NJ 08540 487.00 430.00 376.00 330.00 974.00 861.00 752.00 660.00 901.00 796.00 696.00 611.00 1,509.00 1,334.00 1,166.00 1,023.00 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 430.75 360.92 374.61 281.37 904.57 757.93 786.68 590.88 775.35 649.66 674.30 506.47 1,305.17 1,093.59 1,135.07 852.55 GHI Healthy New York EPO * Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 391.93 332.54 282.54 227.74 862.20 731.61 621.56 501.04 744.64 631.83 536.81 432.71 1,156.16 981.01 833.43 671.86 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 417.23 363.58 314.42 271.64 928.07 808.74 699.38 604.22 792.72 690.79 597.38 516.10 1,215.29 1,059.04 915.83 791.21 HIP Health Plan of New York, Inc. Sole Proprietors/Individuals: P.O. Box 2793 New York, NY 10116 Small Groups: P.O. Box 2806 New York, NY 10116 485.03 401.91 395.06 322.73 970.08 803.80 790.13 645.46 902.17 747.53 734.82 600.27 1,484.21 1,229.81 1,208.90 987.56 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 370.40 305.39 295.29 231.78 740.80 610.78 590.58 463.56 722.30 595.53 575.83 451.99 1,064.90 878.00 848.96 666.37 Oxford Health Plans, Inc. Individual & Sole Proprietors: 14 Central Park Drive Attn: Personal Plans Hooksett, NH 03106 Small Groups: Oxford Health Plans (NY), Inc. 14 Central Park Drive Hooksett, NH 03106 412.85 345.47 320.28 268.97 908.27 760.03 704.62 591.73 809.19 677.12 627.75 527.18 1,341.76 1,122.78 1,040.91 874.15 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 330.74 274.24 265.64 219.81 661.48 548.48 531.28 439.62 628.41 521.06 504.72 417.64 926.07 767.87 743.79 615.47 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 371.50 312.69 324.55 243.76 780.15 656.65 681.56 511.90 668.70 562.84 584.19 438.77 1,125.64 947.45 983.38 738.59 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 380.44 331.53 286.71 247.69 846.23 737.45 637.73 550.94 722.82 629.90 544.73 470.60 1,108.13 965.67 835.10 721.45 HealthNow New York, Inc. d/b/a BlueShield of NENY 30 Century Hill Drive Latham, NY 12110 Long distance Local 321.24 238.44 260.07 181.07 658.55 488.80 533.15 371.20 654.99 486.16 530.15 369.06 930.09 690.34 752.82 524.07 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 348.13 283.12 273.75 214.88 696.26 566.24 547.50 429.76 678.88 552.10 533.83 419.03 1,000.87 813.97 787.03 617.78 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 330.74 274.24 265.64 219.81 661.48 548.48 531.28 439.62 628.41 521.06 504.72 417.64 926.07 767.87 743.79 615.47 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 371.50 312.69 324.55 243.76 780.15 656.65 681.56 511.90 668.70 562.84 584.19 438.77 1,125.64 947.45 983.38 738.59 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 380.44 331.53 286.71 247.69 846.23 737.45 637.73 550.94 722.82 629.90 544.73 470.60 1,108.13 965.67 835.10 721.45 HealthNow New York, Inc. d/b/a BlueShield of NENY 30 Century Hill Drive Latham, NY 12110 Long distance Local 321.24 238.44 260.07 181.07 658.55 488.80 533.15 371.20 654.99 486.16 530.15 369.06 930.09 690.34 752.82 524.07 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 348.13 283.12 273.75 214.88 696.26 566.24 547.50 429.76 678.88 552.10 533.83 419.03 1,000.87 813.97 787.03 617.78 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 330.74 274.24 265.64 219.81 661.48 548.48 531.28 439.62 628.41 521.06 504.72 417.64 926.07 767.87 743.79 615.47 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 371.50 312.69 324.55 243.76 780.15 656.65 681.56 511.90 668.70 562.84 584.19 438.77 1,125.64 947.45 983.38 738.59 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 380.44 331.53 286.71 247.69 846.23 737.45 637.73 550.94 722.82 629.90 544.73 470.60 1,108.13 965.67 835.10 721.45 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 348.13 283.12 273.75 214.88 696.26 566.24 547.50 429.76 678.88 552.10 533.83 419.03 1,000.87 813.97 787.03 617.78 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Central New York Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 367.57 219.08 297.37 171.03 830.71 495.13 672.06 386.55 568.92 339.40 460.27 264.95 1,003.08 598.41 811.53 467.17 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Rochester Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 282.56 186.82 228.61 145.87 696.69 460.62 563.76 359.71 578.35 382.72 467.90 298.80 761.48 503.91 616.19 393.50 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 305.34 240.33 232.38 182.40 610.68 480.66 464.76 364.80 595.43 468.66 453.16 355.69 877.85 690.95 668.09 524.40 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Central New York Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 367.57 219.08 297.37 171.03 830.71 495.13 672.06 386.55 568.92 339.40 460.27 264.95 1,003.08 598.41 811.53 467.17 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 305.34 240.33 232.38 182.40 610.68 480.66 464.76 364.80 595.43 468.66 453.16 355.69 877.85 690.95 668.09 524.40 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Utica/Watertown Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 341.86 222.60 276.56 173.72 683.70 445.21 553.14 347.42 678.78 442.41 549.15 345.24 936.39 610.30 757.56 476.24 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 387.99 322.98 312.29 245.13 775.98 645.96 624.58 490.26 756.61 629.83 608.99 478.02 1,115.47 928.57 897.83 704.75 Aetna Health, Inc. Healthy New York Program 3 Independence Way 4th Floor Princeton, NJ 08540 487.00 430.00 376.00 330.00 974.00 861.00 752.00 660.00 901.00 796.00 696.00 611.00 1,509.00 1,334.00 1,166.00 1,023.00 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 430.75 360.92 374.61 281.37 904.57 757.93 786.68 590.88 775.35 649.66 674.30 506.47 1,305.17 1,093.59 1,135.07 852.55 GHI Healthy New York EPO * Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 391.93 332.54 282.54 227.74 862.20 731.61 621.56 501.04 744.64 631.83 536.81 432.71 1,156.16 981.01 833.43 671.86 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 467.07 407.03 351.99 304.08 1,038.93 905.36 782.93 676.41 887.42 773.33 668.75 577.76 1,360.46 1,185.55 1,025.24 885.73 HIP Health Plan of New York, Inc. Sole Proprietors/Individuals: P.O. Box 2793 New York, NY 10116 Small Groups: P.O. Box 2806 New York, NY 10116 485.03 401.91 395.06 322.73 970.08 803.80 790.13 645.46 902.17 747.53 734.82 600.27 1,484.21 1,229.81 1,208.90 987.56 Managed Health, Inc. d/b/a HealthFirst New York P.O. Box 5193 New York, NY 10274 365.15 321.32 270.16 243.32 729.92 642.33 540.02 486.39 645.93 568.42 477.87 430.43 1,084.46 954.34 802.32 722.66 Oxford Health Plans, Inc. Individual & Sole Proprietors: 14 Central Park Drive Attn: Personal Plans Hooksett, NH 03106 Small Groups: Oxford Health Plans (NY), Inc. 14 Central Park Drive Hooksett, NH 03106 412.85 345.47 320.28 268.97 908.27 760.03 704.62 591.73 809.19 677.12 627.75 527.18 1,341.76 1,122.78 1,040.91 874.15 Aetna Health, Inc. Healthy New York Program 3 Independence Way 4th Floor Princeton, NJ 08540 487.00 430.00 376.00 330.00 974.00 861.00 752.00 660.00 901.00 796.00 696.00 611.00 1,509.00 1,334.00 1,166.00 1,023.00 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 406.74 340.82 353.74 265.67 854.15 715.72 742.86 557.91 732.14 613.48 636.74 478.21 1,232.42 1,032.68 1,071.83 804.98 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 417.23 363.58 314.42 271.64 928.07 808.74 699.38 604.22 792.72 690.79 597.38 516.10 1,215.29 1,059.04 915.83 791.21 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 370.40 305.39 295.29 231.78 740.80 610.78 590.58 463.56 722.30 595.53 575.83 451.99 1,064.90 878.00 848.96 666.37 Oxford Health Plans, Inc. Individual & Sole Proprietors: 14 Central Park Drive Attn: Personal Plans Hooksett, NH 03106 Small Groups: Oxford Health Plans (NY), Inc. 14 Central Park Drive Hooksett, NH 03106 412.85 345.47 320.28 268.97 908.27 760.03 704.62 591.73 809.19 677.12 627.75 527.18 1,341.76 1,122.78 1,040.91 874.15 Aetna Health, Inc. Healthy New York Program 3 Independence Way 4th Floor Princeton, NJ 08540 487.00 430.00 376.00 330.00 974.00 861.00 752.00 660.00 901.00 796.00 696.00 611.00 1,509.00 1,334.00 1,166.00 1,023.00 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 373.38 316.88 299.82 253.99 746.77 633.77 599.64 507.98 709.43 602.08 569.66 482.58 1,045.48 887.28 839.49 711.17 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Central New York Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 367.57 219.08 297.37 171.03 830.71 495.13 672.06 386.55 568.92 339.40 460.27 264.95 1,003.08 598.41 811.53 467.17 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 364.25 299.24 289.34 227.11 728.50 598.48 578.68 454.22 710.31 583.54 564.23 442.88 1,047.22 860.32 831.85 652.94 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Central New York Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 367.57 309.08 297.37 241.24 830.71 698.50 672.06 545.22 568.92 478.78 460.27 373.72 1,003.08 844.17 811.53 658.92 Aetna Health, Inc. Healthy New York Program 3 Independence Way 4th Floor Princeton, NJ 08540 487.00 430.00 376.00 330.00 974.00 861.00 752.00 660.00 901.00 796.00 696.00 611.00 1,509.00 1,334.00 1,166.00 1,023.00 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 390.50 334.00 313.54 267.71 781.00 668.00 627.08 535.42 741.95 634.60 595.73 508.65 1,093.40 935.20 877.91 749.59 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 406.74 340.82 353.74 265.67 854.15 715.72 742.86 557.91 732.14 613.48 636.74 478.21 1,232.42 1,032.68 1,071.83 804.98 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 400.55 349.06 301.85 260.79 890.94 776.43 671.42 580.07 761.01 663.21 573.49 495.48 1,166.66 1,016.72 879.20 759.60 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 370.40 305.39 295.29 231.78 740.80 610.78 590.58 463.56 722.30 595.53 575.83 451.99 1,064.90 878.00 848.96 666.37 Oxford Health Plans, Inc. Individual & Sole Proprietors: 14 Central Park Drive Attn: Personal Plans Hooksett, NH 03106 Small Groups: Oxford Health Plans (NY), Inc. 14 Central Park Drive Hooksett, NH 03106 412.85 345.47 320.28 268.97 908.27 760.03 704.62 591.73 809.19 677.12 627.75 527.18 1,341.76 1,122.78 1,040.91 874.15 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 330.74 274.24 265.64 219.81 661.48 548.48 531.28 439.62 628.41 521.06 504.72 417.64 926.07 767.87 743.79 615.47 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 371.50 312.69 324.55 243.76 780.15 656.65 681.56 511.90 668.70 562.84 584.19 438.77 1,125.64 947.45 983.38 738.59 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 380.44 331.53 286.71 247.69 846.23 737.45 637.73 550.94 722.82 629.90 544.73 470.60 1,108.13 965.67 835.10 721.45 HealthNow New York, Inc. d/b/a BlueShield of NENY 30 Century Hill Drive Latham, NY 12110 Long distance Local 321.24 238.44 260.07 181.07 658.55 488.80 533.15 371.20 654.99 486.16 530.15 369.06 930.09 690.34 752.82 524.07 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 348.13 283.12 273.75 214.88 696.26 566.24 547.50 429.76 678.88 552.10 533.83 419.03 1,000.87 813.97 787.03 617.78 Capital District Physicians' Health Plan 500 Patroon Creek Corporate Center Albany, NY 12206 Sm. Group/Sole Prop. Individuals 330.74 274.24 265.64 219.81 661.48 548.48 531.28 439.62 628.41 521.06 504.72 417.64 926.07 767.87 743.79 615.47 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 371.50 312.69 324.55 243.76 780.15 656.65 681.56 511.90 668.70 562.84 584.19 438.77 1,125.64 947.45 983.38 738.59 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 380.44 331.53 286.71 247.69 846.23 737.45 637.73 550.94 722.82 629.90 544.73 470.60 1,108.13 965.67 835.10 721.45 HealthNow New York, Inc. d/b/a BlueShield of NENY 30 Century Hill Drive Latham, NY 12110 Long distance Local 321.24 238.44 260.07 181.07 658.55 488.80 533.15 371.20 654.99 486.16 530.15 369.06 930.09 690.34 752.82 524.07 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 348.13 283.12 273.75 214.88 696.26 566.24 547.50 429.76 678.88 552.10 533.83 419.03 1,000.87 813.97 787.03 617.78 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Rochester Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 282.56 186.82 228.61 145.87 696.69 460.62 563.76 359.71 578.35 382.72 467.90 298.80 761.48 503.91 616.19 393.50 HealthNow New York, Inc. 1701 North Street Endicott, NY 13760 Long distance Local 329.96 242.19 283.33 202.01 758.92 557.04 651.66 464.62 723.24 530.84 620.91 442.65 921.70 676.51 791.29 564.12 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 305.34 240.33 232.38 182.40 610.68 480.66 464.76 364.80 595.43 468.66 453.16 355.69 877.85 690.95 668.09 524.40 Aetna Health, Inc. Healthy New York Program 3 Independence Way 4th Floor Princeton, NJ 08540 487.00 430.00 376.00 330.00 974.00 861.00 752.00 660.00 901.00 796.00 696.00 611.00 1,509.00 1,334.00 1,166.00 1,023.00 Empire HealthChoice, Inc. d/b/a Empire Blue Cross and Blue Shield HMO Member Services PO Box 1407 Church Street Station New York, NY 10008 430.75 360.92 374.61 281.37 904.57 757.93 786.68 590.88 775.35 649.66 674.30 506.47 1,305.17 1,093.59 1,135.07 852.55 GHI Healthy New York EPO * Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 391.93 332.54 282.54 227.74 862.20 731.61 621.56 501.04 744.64 631.83 536.81 432.71 1,156.16 981.01 833.43 671.86 GHI HMO Healthy New York Sales Direct Pay 55 Water Street - 8th Floor New York, NY 10041-8190 467.07 407.03 351.99 304.08 1,038.93 905.36 782.93 676.41 887.42 773.33 668.75 577.76 1,360.46 1,185.55 1,025.24 885.73 HIP Health Plan of New York, Inc. Sole Proprietors/Individuals: P.O. Box 2793 New York, NY 10116 Small Groups: P.O. Box 2806 New York, NY 10116 485.03 401.91 395.06 322.73 970.08 803.80 790.13 645.46 902.17 747.53 734.82 600.27 1,484.21 1,229.81 1,208.90 987.56 Oxford Health Plans, Inc. Individual & Sole Proprietors: 14 Central Park Drive Attn: Personal Plans Hooksett, NH 03106 Small Groups: Oxford Health Plans (NY), Inc. 14 Central Park Drive Hooksett, NH 03106 412.85 345.47 320.28 268.97 908.27 760.03 704.62 591.73 809.19 677.12 627.75 527.18 1,341.76 1,122.78 1,040.91 874.15 Excellus Health Plan, Inc. d/b/a Univera Healthcare (WNY) Individuals/Sole Proprietors: P.O. Box 23000 Rochester, NY 14692 Small Groups: Attn: Sales Department 205 Park Club Lane Buffalo, NY 14221 278.09 186.09 224.98 145.29 583.99 390.78 472.44 305.10 509.72 341.37 412.35 266.53 849.51 568.95 687.26 444.21 HealthNow New York, Inc. 1701 North Street Endicott, NY 13760 305.99 224.68 254.62 181.71 627.28 460.60 521.96 372.50 623.90 458.10 519.03 370.37 983.88 722.42 818.52 584.08 Independent Health Association, Inc. Independent Health Attn: Sales Dept. 511 Farber Lakes Drive Buffalo, NY 14221 295.75 220.74 222.20 174.21 595.64 444.57 447.51 350.86 521.71 389.39 391.96 307.31 873.35 651.85 656.15 514.44 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 305.34 240.33 232.38 182.40 610.68 480.66 464.76 364.80 595.43 468.66 453.16 355.69 877.85 690.95 668.09 524.40 Excellus Health Plan, Inc. d/b/a Excellus Blue Cross and Blue Shield Rochester Region Individuals/Sole Proprietors: P.O. Box 22999 Rochester, NY 14692 Small Groups: 165 Court Street Rochester, NY 14647 282.56 186.82 228.61 145.87 696.69 460.62 563.76 359.71 578.35 382.72 467.90 298.80 761.48 503.91 616.19 393.50 MVP Health Plan, Inc. 625 State Street Schenectady, NY 12305 305.34 240.33 232.38 182.40 610.68 480.66 464.76 364.80 595.43 468.66 453.16 355.69 877.85 690.95 668.09 524.40