WASHINGTON (SBE) | WA
| Medical (PMPM) | $20.00 |
|---|---|
| Dental (PMPM) | $2.00 |
| Notes | 90% |
UTAH | UT
| Medical (PMPM) | $18.00 |
|---|---|
| Dental (PMPM) | $1.70 |
| Notes | 90% |
OREGON (SBE) | OR
| Medical (PMPM) | $16.00 |
|---|---|
| Dental (PMPM) | $2.00 |
| Notes | 90% |
INDIANA | IN
| Medical (PMPM) | $15.00 |
|---|---|
| Dental (PMPM) | $1.50 |
| Notes | 90% |