| # | Provider | Location | Claims | Total Paid |
|---|---|---|---|---|
| 1 | SOUTHEASTERN MEDICAL CENTER S.C. | HAMMOND, IN | 99 | $593.76 |
| 2 | CHILDREN'S HOSPITAL COLORADO | AURORA, CO | 123 | $448.04 |
| 3 | WELL CARE MEDICAL GROUP OF NORTH LAS VEGAS INCORPORATED | NORTH LAS VEGAS, NV | 372 | $0.00 |
| 4 | SHRINERS HOSPITALS FOR CHILDREN | GREENVILLE, SC | 13 | $0.00 |