▸ Hospital · MA · CCN 220001
Health Alliance - Clinton Hospital
60 HOSPITAL ROAD, LEOMINSTER, MA, 220001
Compliance grade
A
100/100
Procedures tracked
163
of 209 target codes
Payers
30
with negotiated rates
Rates published
60,034
last crawl 2026-05-23
Procedures & rates
| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| behavioral | ||||||||
| Psychoses | MS-DRG | 885 | 21 | $49,678 | $49,678 | $758.07 | $1,594 | $13,546 |
| Psychiatric diagnostic evaluation | CPT | 90791 | 21 | $986 | $986 | $27.57 | $517.65 | $986 |
| Psychiatric eval with medical services | CPT | 90792 | 20 | $801 | $801 | $27.57 | $424.53 | $801 |
| Psychotherapy 30 minutes | CPT | 90832 | 21 | $708 | $708 | $21.76 | $349.88 | $708 |
| Psychotherapy 45 minutes | CPT | 90834 | 22 | $630 | $630 | $27.57 | $294.3 | $630 |
| Psychotherapy 60 minutes | CPT | 90837 | 20 | $911 | $911 | $27.57 | $464.61 | $911 |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 21 | $532 | $532 | $27.57 | $285.68 | $532 |
| emergency | ||||||||
| ED visit level 1 | CPT | 99281 | 24 | $469 | $469 | $102.31 | $246.23 | $643 |
| ED visit level 2 | CPT | 99282 | 24 | $622 | $622 | $150.7 | $326.55 | $656.87 |
| ED visit level 3 | CPT | 99283 | 32 | $1,339 | $1,339 | $266.22 | $412.34 | $1,339 |
| ED visit level 4 | CPT | 99284 | 32 | $1,828 | $1,828 | $294.3 | $600.86 | $1,828 |
| ED visit level 5 | CPT | 99285 | 32 | $2,135 | $2,135 | $294.3 | $749.4 | $2,135 |
| Critical care, first hour | CPT | 99291 | 32 | $2,826 | $2,826 | $294.3 | $1,039.45 | $2,826 |
| imaging | ||||||||
| CT head without contrast | CPT | 70450 | 30 | $2,744 | $2,744 | $113.66 | $133.19 | $2,744 |
| CT head with contrast | CPT | 70460 | 30 | $2,763 | $2,763 | $190.27 | $287.2 | $2,763 |
| CT head with and without contrast | CPT | 70470 | 30 | $2,932 | $2,932 | $190.27 | $320.24 | $2,932 |
| CT neck with contrast | CPT | 70491 | 30 | $2,799 | $2,799 | $190.27 | $303.77 | $2,799 |
| MRI brain without contrast | CPT | 70551 | 30 | $3,400 | $3,400 | $258.35 | $401.1 | $3,400 |
| MRI brain with and without contrast | CPT | 70553 | 30 | $4,079 | $4,079 | $294.3 | $586.46 | $4,079 |
| Chest X-ray single view | CPT | 71045 | 33 | $18,570 | $18,570 | $2.89 | $276 | $13,147 |
| Chest X-ray 2 views | CPT | 71046 | 33 | $3,415 | $3,415 | $8.35 | $110.87 | $3,290.17 |
| Chest X-ray 3 views | CPT | 71047 | 31 | $432 | $432 | $94.11 | $135.79 | $432 |
| CT chest without contrast | CPT | 71250 | 30 | $2,211 | $2,211 | $113.66 | $215.76 | $2,211 |
| CT chest with contrast | CPT | 71260 | 30 | $7,842.56 | $7,842.56 | $190.27 | $250.82 | $2,861 |
| CT chest with and without contrast | CPT | 71270 | 30 | $2,873 | $2,873 | $190.27 | $685.17 | $2,873 |
| MRI chest without contrast | CPT | 71550 | 30 | $3,400 | $3,400 | $258.35 | $401.1 | $3,400 |
| Lumbosacral spine X-ray | CPT | 72100 | 32 | $512 | $512 | $33.42 | $191.68 | $512 |
| CT cervical spine without contrast | CPT | 72125 | 30 | $2,351 | $2,351 | $113.66 | $249.03 | $2,351 |
| CT thoracic spine without contrast | CPT | 72128 | 30 | $2,297 | $2,297 | $113.66 | $249.03 | $2,297 |
| CT lumbar spine without contrast | CPT | 72131 | 30 | $2,386 | $2,386 | $113.66 | $249.03 | $2,386 |
| MRI cervical spine without contrast | CPT | 72141 | 31 | $3,774 | $3,774 | $151.98 | $319.43 | $3,774 |
| MRI thoracic spine without contrast | CPT | 72146 | 31 | $3,774 | $3,774 | $151.98 | $319.43 | $3,774 |
| MRI lumbar spine without contrast | CPT | 72148 | 31 | $3,774 | $3,774 | $151.98 | $319.43 | $3,774 |
| MRI cervical spine with and without contrast | CPT | 72156 | 31 | $4,079 | $4,079 | $222.22 | $534.42 | $4,079 |
| MRI lumbar spine with contrast | CPT | 72158 | 31 | $4,079 | $4,079 | $222.22 | $534.42 | $4,079 |
| CT pelvis without contrast | CPT | 72192 | 30 | $2,371 | $2,371 | $113.66 | $245.55 | $2,371 |
| CT pelvis with contrast | CPT | 72193 | 30 | $2,387 | $2,387 | $190.27 | $313.42 | $2,387 |
| Shoulder X-ray | CPT | 73030 | 32 | $1,306 | $1,306 | $26.05 | $148.9 | $555.8 |
| Humerus X-ray | CPT | 73060 | 32 | $284 | $284 | $26.05 | $110.87 | $294.3 |
| Hand X-ray 3 views | CPT | 73130 | 32 | $319 | $319 | $26.84 | $112.98 | $373.26 |
| MRI upper extremity joint without contrast | CPT | 73221 | 30 | $3,400 | $3,400 | $258.35 | $401.1 | $3,400 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 30 | $6,051 | $6,051 | $294.3 | $586.46 | $6,051 |
| Knee X-ray 1-2 views | CPT | 73560 | 32 | $58,666 | $58,666 | $24.53 | $133.19 | $26,496 |
| Ankle X-ray 3 views | CPT | 73610 | 32 | $319 | $319 | $26.84 | $110.87 | $319 |
| MRI lower extremity joint without contrast | CPT | 73721 | 30 | $3,400 | $3,400 | $258.35 | $401.1 | $3,400 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 30 | $6,051 | $6,051 | $294.3 | $586.46 | $6,051 |
| CT abdomen without contrast | CPT | 74150 | 30 | $2,386 | $2,386 | $113.66 | $242.64 | $2,386 |
| CT abdomen with contrast | CPT | 74160 | 30 | $2,805 | $2,805 | $190.27 | $327.68 | $2,805 |
| CT abdomen with and without contrast | CPT | 74170 | 30 | $2,843 | $2,843 | $190.27 | $328.15 | $2,843 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 30 | $4,692 | $4,692 | $258.35 | $303.97 | $4,692 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 30 | $7,842.56 | $7,842.56 | $250.82 | $444.45 | $4,816 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 30 | $5,021 | $5,021 | $294.3 | $586.46 | $5,021 |
| MRI abdomen without contrast | CPT | 74181 | 30 | $3,400 | $3,400 | $258.35 | $401.1 | $3,400 |
| MRI abdomen with and without contrast | CPT | 74183 | 30 | $4,506 | $4,506 | $294.3 | $586.46 | $4,506 |
| Abdominal ultrasound complete | CPT | 76700 | 30 | $1,237 | $1,237 | $111.92 | $135.72 | $1,237 |
| Abdominal ultrasound limited | CPT | 76705 | 30 | $2,271 | $2,271 | $84.33 | $133.19 | $621 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 30 | $1,233 | $1,233 | $110.08 | $133.19 | $1,233 |
| Obstetric ultrasound first trimester | CPT | 76801 | 31 | $633 | $633 | $101.64 | $202.88 | $633 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 31 | $1,237 | $1,237 | $113.66 | $202.88 | $1,237 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 31 | $1,237 | $1,237 | $151.89 | $309.76 | $1,237 |
| Transvaginal ultrasound | CPT | 76830 | 31 | $1,254 | $1,254 | $96.43 | $133.19 | $643 |
| Pelvic ultrasound complete | CPT | 76856 | 31 | $3,005 | $3,005 | $96.89 | $133.19 | $712 |
| Scrotal ultrasound | CPT | 76870 | 30 | $1,237 | $1,237 | $97.82 | $167.04 | $1,237 |
| Diagnostic mammography unilateral | CPT | 77065 | 32 | $19,042 | $19,042 | $90.66 | $235.15 | $1,660 |
| Diagnostic mammography bilateral | CPT | 77066 | 32 | $971 | $971 | $116.25 | $294.3 | $971 |
| Screening mammography bilateral | CPT | 77067 | 31 | $734 | $734 | $50.36 | $144.21 | $734 |
| EKG complete | CPT | 93000 | 28 | $124 | $124 | $40.76 | $124 | $294.3 |
| EKG tracing only | CPT | 93005 | 32 | $176 | $176 | $57.85 | $91.52 | $294.3 |
| Transthoracic echocardiogram complete | CPT | 93306 | 32 | $2,647 | $2,647 | $294.3 | $1,158.35 | $2,647 |
| Transthoracic echocardiogram | CPT | 93307 | 32 | $1,611 | $1,611 | $171.21 | $426.34 | $2,000.8 |
| inpatient | ||||||||
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 22 | $39,879 | $39,879 | $758.07 | $18,560 | $25,220 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 22 | $26,499 | $26,499 | $758.07 | $9,493.7 | $12,893 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 22 | $26,647 | $26,647 | $758.07 | $6,540.99 | $8,726.47 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 22 | $42,926 | $42,926 | $758.07 | $14,499 | $20,494 |
| COPD w MCC | MS-DRG | 190 | 23 | $53,493 | $53,493 | $758.07 | $10,519 | $32,181 |
| COPD w CC | MS-DRG | 191 | 22 | $21,334 | $21,334 | $758.07 | $7,977.92 | $10,892 |
| COPD w/o CC/MCC | MS-DRG | 192 | 23 | $53,169 | $53,169 | $758.07 | $6,206.5 | $51,005 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 23 | $48,748 | $48,748 | $758.07 | $7,820.82 | $44,605 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 22 | $13,404 | $13,404 | $758.07 | $6,034.51 | $7,894.77 |
| AMI discharged alive w MCC | MS-DRG | 280 | 23 | $68,271 | $68,271 | $758.07 | $15,075 | $67,542 |
| AMI discharged alive w CC | MS-DRG | 281 | 22 | $21,821 | $21,821 | $758.07 | $8,828.38 | $33,726 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 22 | $65,161 | $65,161 | $758.07 | $7,053.98 | $79,007 |
| Heart failure & shock w MCC | MS-DRG | 291 | 22 | $27,547 | $27,547 | $758.07 | $11,972 | $16,543 |
| Heart failure & shock w CC | MS-DRG | 292 | 22 | $25,180 | $25,180 | $758.07 | $8,032.28 | $10,919 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 23 | $72,252 | $72,252 | $758.07 | $11,403 | $56,169 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 22 | $20,199 | $20,199 | $758.07 | $7,005.76 | $9,373.07 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 22 | $17,872 | $17,872 | $758.07 | $5,469.16 | $7,093.5 |
| GI hemorrhage w CC | MS-DRG | 378 | 22 | $33,378 | $33,378 | $758.07 | $9,225.51 | $12,500 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 22 | $17,574 | $17,574 | $758.07 | $6,051.74 | $8,072.27 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 22 | $22,579 | $22,579 | $758.07 | $7,403.51 | $9,892.87 |
| Kidney/UTI w MCC | MS-DRG | 689 | 22 | $28,543 | $28,543 | $758.07 | $10,853 | $14,837 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 22 | $22,680 | $22,680 | $758.07 | $7,674.41 | $10,176 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 22 | $39,091 | $39,091 | $758.07 | $17,940 | $24,876 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 22 | $27,731 | $27,731 | $758.07 | $9,611.46 | $13,071 |
| lab | ||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 32 | $90 | $90 | $7.46 | $14.39 | $294.3 |
| General health panel | CPT | 80050 | 31 | $291 | $291 | $17.65 | $156.8 | $294.3 |
| Electrolyte panel | CPT | 80051 | 32 | $120 | $120 | $6.18 | $18.65 | $294.3 |
| Comprehensive metabolic panel | CPT | 80053 | 32 | $130 | $130 | $10.56 | $17.96 | $294.3 |
| Lipid panel | CPT | 80061 | 33 | $133 | $133 | $11.81 | $34.77 | $294.3 |
| Renal function panel | CPT | 80069 | 32 | $125 | $125 | $7.65 | $25.62 | $294.3 |
| Hepatic function panel | CPT | 80076 | 32 | $213 | $213 | $7.2 | $21.59 | $294.3 |
| Urinalysis non-automated | CPT | 81002 | 33 | $27 | $27 | $2.44 | $4.1 | $294.3 |
| Urinalysis automated | CPT | 81003 | 33 | $49 | $49 | $1.98 | $5.76 | $294.3 |
| Glucose quantitative | CPT | 82947 | 33 | $42 | $42 | $3.47 | $13.22 | $294.3 |
| Hemoglobin A1c | CPT | 83036 | 33 | $86 | $86 | $8.56 | $12.01 | $294.3 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 33 | $324 | $324 | $14.82 | $24.55 | $324 |
| Complete blood count with automated differential | CPT | 85025 | 33 | $114 | $114 | $6.85 | $8.56 | $294.3 |
| Complete blood count without differential | CPT | 85027 | 33 | $49 | $49 | $5.71 | $15.26 | $294.3 |
| Urine culture bacterial | CPT | 87086 | 33 | $131 | $131 | $7.12 | $9.99 | $294.3 |
| Urine culture identification | CPT | 87088 | 33 | $69.1 | $69.1 | $7.13 | $19.48 | $294.3 |
| Tissue exam by pathologist level IV | CPT | 88305 | 32 | $288 | $288 | $27.79 | $93.98 | $294.3 |
| maternity | ||||||||
| Fetal non-stress test | CPT | 59025 | 32 | $641 | $641 | $13.23 | $308.99 | $641 |
| Vaginal delivery only | CPT | 59409 | 22 | $6,262 | $6,262 | $294.3 | $4,095.35 | $6,813.96 |
| C-section delivery only | CPT | 59514 | 32 | $12,180 | $12,180 | $294.3 | $2,770.05 | $12,180 |
| Vaginal delivery w complicating dx | MS-DRG | 774 | 1 | $22,942 | $22,942 | $16,913 | $18,181 | $19,450 |
| Vaginal delivery w/o complicating dx | MS-DRG | 775 | 1 | $42,996 | $42,996 | $8,903.04 | $18,296 | $64,933 |
| office | ||||||||
| Office visit, new patient, 15-29 min | CPT | 99202 | 30 | $304 | $304 | $23.04 | $166.89 | $304 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 30 | $528 | $528 | $23.04 | $169.61 | $528 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 30 | $773 | $773 | $23.04 | $172.84 | $773 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 30 | $1,017 | $1,017 | $23.04 | $290.25 | $1,017 |
| Office visit, established patient, 5 min | CPT | 99211 | 30 | $257 | $257 | $22.67 | $161.53 | $294.3 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 30 | $291 | $291 | $23.04 | $166.89 | $294.3 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 30 | $484 | $484 | $23.04 | $172.84 | $484 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 30 | $686 | $686 | $23.04 | $169.61 | $686 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 30 | $926 | $926 | $23.04 | $172.84 | $926 |
| preventive | ||||||||
| Upper GI endoscopy diagnostic | CPT | 43235 | 32 | $8,377.23 | $8,377.23 | $294.3 | $1,508.22 | $4,409.2 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 32 | $14,790 | $14,790 | $55.58 | $1,155.45 | $4,409.2 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 32 | $5,910.5 | $5,910.5 | $47 | $1,175.24 | $3,290.17 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 32 | $6,814.11 | $6,814.11 | $27.79 | $1,170.23 | $3,290.17 |
| Colonoscopy diagnostic | CPT | 45378 | 32 | $7,770.94 | $7,770.94 | $294.3 | $1,170.23 | $4,409.2 |
| Colonoscopy with biopsy | CPT | 45380 | 32 | $13,178 | $13,178 | $55.58 | $1,505.82 | $4,409.2 |
| Colonoscopy with polyp removal | CPT | 45385 | 32 | $23,918 | $23,918 | $27.79 | $1,505.82 | $4,644 |
| surgery | ||||||||
| Total shoulder arthroplasty | CPT | 23472 | 23 | $113,565 | $113,565 | $2.89 | $21,273 | $36,186 |
| PCI w drug-eluting stent w MCC | MS-DRG | 246 | 1 | $16,531 | $16,531 | $14,561 | $15,653 | $16,746 |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 1 | $31,381 | $31,381 | $11,565 | $16,647 | $55,442 |
| Total hip replacement | CPT | 27130 | 22 | $60,410 | $60,410 | $1.44 | $15,577 | $26,496 |
| Total knee replacement | CPT | 27447 | 22 | $59,236 | $59,236 | $25.11 | $15,577 | $26,496 |
| Knee revision arthroplasty single component | CPT | 27486 | 23 | $36,800 | $36,800 | $8.35 | $15,577 | $26,496 |
| Knee revision arthroplasty all components | CPT | 27487 | 23 | $120,296 | $120,296 | $8.35 | $20,138 | $36,186 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 24 | $33,644 | $33,644 | $294.3 | $5,129.63 | $14,975 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 24 | $35,059 | $35,059 | $294.3 | $8,803.83 | $14,975 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 24 | $16,261 | $16,261 | $294.3 | $3,969.86 | $6,752.73 |
| ACL reconstruction | CPT | 29888 | 25 | $56,974 | $56,974 | $51.31 | $8,219.54 | $14,975 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 22 | $84,731 | $84,731 | $758.07 | $41,985 | $58,217 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 22 | $59,186 | $59,186 | $758.07 | $22,059 | $29,968 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 22 | $36,488 | $36,488 | $758.07 | $15,588 | $20,932 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 22 | $49,379 | $49,379 | $758.07 | $15,666 | $21,026 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 22 | $44,219 | $44,219 | $758.07 | $12,715 | $16,705 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 1 | $37,246 | $37,246 | $11,159 | $17,974 | $50,642 |
| Laparoscopic appendectomy | CPT | 44970 | 24 | $24,817 | $24,817 | $25.11 | $7,334.93 | $12,477 |
| Major joint replacement w MCC | MS-DRG | 469 | 22 | $102,173 | $102,173 | $758.07 | $27,821 | $55,252 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 22 | $75,761 | $75,761 | $758.07 | $18,221 | $30,765 |
| Laparoscopic cholecystectomy | CPT | 47562 | 24 | $21,593 | $21,593 | $2.89 | $7,334.93 | $13,451 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 24 | $22,181 | $22,181 | $25.11 | $7,334.93 | $13,451 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 21 | $95,225 | $95,225 | $758.07 | $26,726 | $37,287 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 21 | $71,567 | $71,567 | $758.07 | $19,317 | $26,306 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 22 | $57,486 | $57,486 | $758.07 | $15,117 | $20,113 |
| Lap inguinal hernia repair | CPT | 49650 | 24 | $27,276 | $27,276 | $294.3 | $7,334.93 | $12,477 |
| Lap salpingo-oophorectomy | CPT | 58661 | 26 | $21,517 | $21,517 | $6.52 | $6,235.79 | $12,477 |
| Complex cataract surgery | CPT | 66982 | 23 | $23,061 | $23,061 | $294.3 | $2,800.04 | $10,363 |
| Cataract surgery with lens implant | CPT | 66984 | 24 | $35,304 | $35,304 | $2.89 | $2,800.04 | $10,363 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 22 | $28,743 | $28,743 | $758.07 | $11,581 | $15,197 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 22 | $28,436 | $28,436 | $758.07 | $18,905 | $24,773 |
Payer mix (top 30)
| Payer | Codes covered | Median rate |
|---|---|---|
| Aetna | 158 | $429.77 |
| Blue Cross Blue Shield | 158 | $418.69 |
| Cigna | 158 | $678.58 |
| hsno/free care [10801] | 158 | $294.3 |
| institution [10406] | 158 | $289.49 |
| tufts [11201] | 158 | $616.85 |
| UnitedHealthcare | 158 | $351.07 |
| correctional care [11003] | 152 | $423.28 |
| senior whole health [10110] | 152 | $452.91 |
| harvard pilgrim mcr [10106] | 152 | $444.45 |
| Medicare | 152 | $289.49 |
| tufts connectorcare [10507] | 149 | $492.43 |
| tufts mcr [10112] | 149 | $303.97 |
| commonwealth care mcr [10115] | 149 | $303.97 |
| mgb mcr [10124] | 149 | $303.97 |
| tufts dual [10111] | 149 | $289.49 |
| fallon mcr supp [20202] | 147 | $303.97 |
| wellpoint [11112] | 144 | $590.82 |
| fallon carelon hlth [28] | 142 | $1,828 |
| fallon mcaid carelon hlth [29] | 142 | $1,814.19 |
| hne [11108] | 133 | $1,377.46 |
| Medicaid | 121 | $126.84 |
| workers compensation [20501] | 121 | $284.08 |
| CHAMPVA | 117 | $190.27 |
| tufts us family [11203] | 115 | $212.81 |
| fallon connectorcare [10503] | 112 | $814 |
| grants [20507] | 108 | $633 |
| connecticare [11105] | 105 | $749 |
| Multiplan | 105 | $561.75 |
| First Health | 105 | $561.75 |