| Anderson | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Andrews | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Angelina | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Aransas | CHP TX Silver HD | $478 | $955 | $1,241 |
| Archer | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $619 | $1,239 | $1,609 |
| Armstrong | Silver 100% H S A | $501 | $1,003 | $1,303 |
| Atascosa | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $559 | $1,118 | $1,453 |
| Austin | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $545 | $1,089 | $1,415 |
| Bailey | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Bandera | Ambetter Balanced Care 5 | $426 | $852 | $1,107 |
| Bastrop | IdealCare Complete by Sendero Health Plans | $455 | $909 | $1,181 |
| Baylor | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Bee | CHP TX Silver HD | $458 | $916 | $1,190 |
| Bell | Ambetter Balanced Care 5 | $433 | $865 | $1,124 |
| Bexar | Saver Silver | $369 | $737 | $958 |
| Blanco | Ambetter Balanced Care 5 | $295 | $590 | $767 |
| Borden | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Bosque | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Bowie | CHP TX Silver HD | $457 | $914 | $1,188 |
| Brazoria | Ambetter Balanced Care 5 | $390 | $779 | $1,012 |
| Brazos | Ambetter Balanced Care 5 | $403 | $805 | $1,046 |
| Brewster | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Briscoe | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Brooks | Ambetter Balanced Care 5 | $295 | $590 | $767 |
| Brown | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Burleson | Ambetter Balanced Care 5 | $403 | $805 | $1,046 |
| Burnet | Ambetter Balanced Care 5 | $295 | $590 | $767 |
| Caldwell | IdealCare Complete by Sendero Health Plans | $455 | $909 | $1,181 |
| Calhoun | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $556 | $1,112 | $1,445 |
| Callahan | Silver 100% H S A | $520 | $1,041 | $1,352 |
| Cameron | Ambetter Balanced Care 5 | $347 | $693 | $901 |
| Camp | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Carson | Silver 100% H S A | $501 | $1,003 | $1,303 |
| Cass | CHP TX Silver HD | $458 | $916 | $1,190 |
| Castro | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Chambers | Community Health Choice HMO Silver 004 | $460 | $919 | $1,194 |
| Cherokee | CHP TX Silver HD | $458 | $916 | $1,190 |
| Childress | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Clay | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $619 | $1,239 | $1,609 |
| Cochran | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Coke | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Coleman | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Collin | Molina Marketplace Silver Plan | $411 | $823 | $1,069 |
| Collingsworth | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Colorado | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Comal | Saver Silver | $369 | $737 | $958 |
| Comanche | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Concho | Ambetter Balanced Care 5 | $295 | $590 | $767 |
| Cooke | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Coryell | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $526 | $1,052 | $1,367 |
| Cottle | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Crane | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Crockett | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Crosby | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Culberson | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Dallam | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Dallas | Molina Marketplace Silver Plan | $411 | $823 | $1,069 |
| Dawson | Silver 100% H S A | $539 | $1,078 | $1,401 |
| DeWitt | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Deaf Smith | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Delta | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $570 | $1,140 | $1,481 |
| Denton | Ambetter Balanced Care 5 | $415 | $830 | $1,079 |
| Dickens | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Dimmit | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Donley | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Duval | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Eastland | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Ector | Silver 100% H S A | $488 | $976 | $1,268 |
| Edwards | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| El Paso | Ambetter Balanced Care 5 | $380 | $760 | $987 |
| Ellis | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $570 | $1,140 | $1,481 |
| Erath | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Falls | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Fannin | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Fayette | Ambetter Balanced Care 5 | $295 | $590 | $767 |
| Fisher | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Floyd | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Foard | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Fort Bend | Ambetter Balanced Care 5 | $390 | $779 | $1,012 |
| Franklin | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Freestone | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Frio | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Gaines | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Galveston | Community Health Choice HMO Silver 004 | $460 | $919 | $1,194 |
| Garza | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Gillespie | Ambetter Balanced Care 5 | $295 | $590 | $767 |
| Glasscock | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Goliad | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $556 | $1,112 | $1,445 |
| Gonzales | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Gray | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Grayson | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $583 | $1,166 | $1,514 |
| Gregg | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $540 | $1,080 | $1,404 |
| Grimes | Ambetter Balanced Care 5 | $295 | $590 | $767 |
| Guadalupe | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $559 | $1,118 | $1,453 |
| Hale | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Hall | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Hamilton | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Hansford | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Hardeman | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Hardin | CHP TX Silver HD | $494 | $989 | $1,285 |
| Harris | Ambetter Balanced Care 5 | $390 | $779 | $1,012 |
| Harrison | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Hartley | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Haskell | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Hays | Saver Silver | $404 | $807 | $1,049 |
| Hemphill | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Henderson | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Hidalgo | Ambetter Balanced Care 5 | $319 | $638 | $829 |
| Hill | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Hockley | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Hood | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Hopkins | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Houston | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Howard | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Hudspeth | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Hunt | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $570 | $1,140 | $1,481 |
| Hutchinson | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Irion | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $622 | $1,243 | $1,616 |
| Jack | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Jackson | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Jasper | CHP TX Silver HD | $458 | $916 | $1,190 |
| Jeff Davis | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Jefferson | Classic Silver | $407 | $815 | $1,058 |
| Jim Hogg | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Jim Wells | CHP TX Silver HD | $458 | $916 | $1,190 |
| Johnson | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $570 | $1,140 | $1,481 |
| Jones | Silver 100% H S A | $520 | $1,041 | $1,352 |
| Karnes | CHP TX Silver HD | $458 | $916 | $1,190 |
| Kaufman | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $570 | $1,140 | $1,481 |
| Kendall | Ambetter Balanced Care 5 | $426 | $852 | $1,107 |
| Kenedy | CHP TX Silver HD | $458 | $916 | $1,190 |
| Kent | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Kerr | Ambetter Balanced Care 5 | $295 | $590 | $767 |
| Kimble | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| King | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Kinney | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Kleberg | CHP TX Silver HD | $458 | $916 | $1,190 |
| Knox | Silver 100% H S A | $539 | $1,078 | $1,401 |
| La Salle | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Lamar | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Lamb | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Lampasas | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $526 | $1,052 | $1,367 |
| Lavaca | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Lee | Ambetter Balanced Care 5 | $295 | $590 | $767 |
| Leon | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Liberty | Community Health Choice HMO Silver 004 | $460 | $919 | $1,194 |
| Limestone | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Lipscomb | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Live Oak | CHP TX Silver HD | $458 | $916 | $1,190 |
| Llano | Ambetter Balanced Care 5 | $295 | $590 | $767 |
| Loving | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Lubbock | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Lynn | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Madison | Ambetter Balanced Care 5 | $295 | $590 | $767 |
| Marion | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Martin | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Mason | Ambetter Balanced Care 5 | $295 | $590 | $767 |
| Matagorda | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Maverick | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| McCulloch | Ambetter Balanced Care 5 | $295 | $590 | $767 |
| McLennan | Ambetter Balanced Care 5 | $335 | $670 | $870 |
| McMullen | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Medina | Ambetter Balanced Care 5 | $426 | $852 | $1,107 |
| Menard | Ambetter Balanced Care 5 | $295 | $590 | $767 |
| Midland | Silver 100% H S A | $523 | $1,046 | $1,359 |
| Milam | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Mills | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Mitchell | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Montague | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Montgomery | Ambetter Balanced Care 5 | $390 | $779 | $1,012 |
| Moore | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Morris | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Motley | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Nacogdoches | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Navarro | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Newton | CHP TX Silver HD | $458 | $916 | $1,190 |
| Nolan | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Nueces | CHP TX Silver HD | $478 | $955 | $1,241 |
| Ochiltree | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Oldham | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Orange | Community Health Choice HMO Silver 004 | $460 | $919 | $1,194 |
| Palo Pinto | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Panola | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Parker | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $570 | $1,140 | $1,481 |
| Parmer | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Pecos | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Polk | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Potter | Silver 100% H S A | $501 | $1,003 | $1,303 |
| Presidio | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Rains | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Randall | Silver 100% H S A | $501 | $1,003 | $1,303 |
| Reagan | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Real | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Red River | CHP TX Silver HD | $458 | $916 | $1,190 |
| Reeves | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Refugio | CHP TX Silver HD | $458 | $916 | $1,190 |
| Roberts | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Robertson | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $563 | $1,127 | $1,464 |
| Rockwall | Ambetter Balanced Care 5 | $415 | $830 | $1,079 |
| Runnels | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Rusk | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $540 | $1,080 | $1,404 |
| Sabine | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| San Augustine | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| San Jacinto | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $545 | $1,089 | $1,415 |
| San Patricio | CHP TX Silver HD | $478 | $955 | $1,241 |
| San Saba | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Schleicher | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Scurry | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Shackelford | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Shelby | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Sherman | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Smith | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $524 | $1,048 | $1,362 |
| Somervell | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Starr | Molina Marketplace Silver Plan | $391 | $783 | $1,017 |
| Stephens | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Sterling | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Stonewall | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Sutton | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Swisher | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Tarrant | Ambetter Balanced Care 5 | $415 | $830 | $1,079 |
| Taylor | Silver 100% H S A | $520 | $1,041 | $1,352 |
| Terrell | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Terry | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Throckmorton | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Titus | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Tom Green | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $622 | $1,243 | $1,616 |
| Travis | Saver Silver | $404 | $807 | $1,049 |
| Trinity | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Tyler | CHP TX Silver HD | $458 | $916 | $1,190 |
| Upshur | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $540 | $1,080 | $1,404 |
| Upton | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Uvalde | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Val Verde | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Van Zandt | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Victoria | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $556 | $1,112 | $1,445 |
| Walker | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Waller | Community Health Choice HMO Silver 004 | $460 | $919 | $1,194 |
| Ward | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Washington | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Webb | Molina Marketplace Silver Plan | $387 | $775 | $1,007 |
| Wharton | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Wheeler | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Wichita | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $619 | $1,239 | $1,609 |
| Wilbarger | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Willacy | Ambetter Balanced Care 5 | $295 | $590 | $767 |
| Williamson | Saver Silver | $404 | $807 | $1,049 |
| Wilson | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $559 | $1,118 | $1,453 |
| Winkler | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Wise | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $570 | $1,140 | $1,481 |
| Wood | CHP TX Silver HD | $458 | $916 | $1,190 |
| Yoakum | Silver 100% H S A | $539 | $1,078 | $1,401 |
| Young | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Zapata | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |
| Zavala | Blue Advantage Silver HMO 205 - Two $25 PCP Visits | $549 | $1,097 | $1,426 |