▸ Hospital · WV · CCN 511301
WEBSTER COUNTY MEMORIAL HOSPITAL
324 MILLER MOUNTAIN ROAD, WEBSTER SPRINGS, WV, 26288-
25 bedsCritical Access Hospitals9
Compliance grade
A
100/100
Procedures tracked
157
of 209 target codes
Payers
30
with negotiated rates
Rates published
52,218
last crawl 2026-05-24
Procedures & rates
| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| behavioral | ||||||||
| Psychoses | MS-DRG | 885 | 19 | $20,161 | $20,161 | $1,252.6 | $13,213 | $18,405 |
| Psychiatric diagnostic evaluation | CPT | 90791 | 22 | $1,418 | $1,418 | $29.38 | $302 | $1,418 |
| Psychiatric eval with medical services | CPT | 90792 | 22 | $302 | $302 | $29.38 | $247.64 | $727.21 |
| Psychotherapy 30 minutes | CPT | 90832 | 22 | $368 | $368 | $29.38 | $301.76 | $680.81 |
| Psychotherapy 45 minutes | CPT | 90834 | 22 | $1,156 | $1,156 | $29.38 | $401 | $680.81 |
| Psychotherapy 60 minutes | CPT | 90837 | 22 | $550 | $550 | $29.38 | $451 | $690.91 |
| emergency | ||||||||
| ED visit level 1 | CPT | 99281 | 23 | $163 | $163 | $79.51 | $138.42 | $680.81 |
| ED visit level 2 | CPT | 99282 | 23 | $355 | $355 | $40.76 | $252.33 | $680.81 |
| ED visit level 3 | CPT | 99283 | 31 | $499 | $499 | $61.68 | $351.07 | $5,775.39 |
| ED visit level 4 | CPT | 99284 | 31 | $921 | $921 | $115.92 | $541.69 | $5,775.39 |
| ED visit level 5 | CPT | 99285 | 31 | $1,083 | $1,083 | $171.45 | $749.4 | $5,775.39 |
| Critical care, first hour | CPT | 99291 | 31 | $3,499 | $3,499 | $242 | $1,243.16 | $5,775.39 |
| imaging | ||||||||
| CT head without contrast | CPT | 70450 | 28 | $1,625 | $1,625 | $125.29 | $135.72 | $1,625 |
| CT head with contrast | CPT | 70460 | 28 | $2,408 | $2,408 | $211.41 | $680.81 | $2,408 |
| CT head with and without contrast | CPT | 70470 | 28 | $2,735 | $2,735 | $211.41 | $685.17 | $2,735 |
| CT neck with contrast | CPT | 70491 | 28 | $2,113 | $2,113 | $211.41 | $680.81 | $2,113 |
| MRI brain without contrast | CPT | 70551 | 28 | $3,818 | $3,818 | $287.06 | $891 | $3,818 |
| MRI brain with contrast | CPT | 70552 | 19 | $4,650 | $4,650 | $444.45 | $3,538.65 | $4,650 |
| MRI brain with and without contrast | CPT | 70553 | 28 | $5,257 | $5,257 | $423.28 | $1,406 | $5,257 |
| Chest X-ray single view | CPT | 71045 | 31 | $13,895 | $13,895 | $39.96 | $204.75 | $6,516.39 |
| Chest X-ray 2 views | CPT | 71046 | 32 | $20,166 | $20,166 | $53.87 | $185.64 | $6,516.39 |
| Chest X-ray 3 views | CPT | 71047 | 31 | $407 | $407 | $66.98 | $194.72 | $680.81 |
| CT chest without contrast | CPT | 71250 | 28 | $1,687 | $1,687 | $126.29 | $494.05 | $1,687 |
| CT chest with contrast | CPT | 71260 | 28 | $6,489.35 | $6,489.35 | $210.21 | $352.8 | $2,109 |
| CT chest with and without contrast | CPT | 71270 | 28 | $3,435 | $3,435 | $211.41 | $2,221.33 | $3,435 |
| MRI chest without contrast | CPT | 71550 | 28 | $2,360 | $2,360 | $287.06 | $891 | $2,360 |
| MRI chest with contrast | CPT | 71551 | 19 | $2,327 | $2,327 | $680.81 | $1,976.09 | $3,037.67 |
| MRI chest with and without contrast | CPT | 71552 | 28 | $3,211 | $3,211 | $423.28 | $1,393.6 | $3,211 |
| Lumbosacral spine X-ray | CPT | 72100 | 31 | $628 | $628 | $33.42 | $245.32 | $680.81 |
| CT cervical spine without contrast | CPT | 72125 | 28 | $2,030 | $2,030 | $126.29 | $494.05 | $2,030 |
| CT thoracic spine without contrast | CPT | 72128 | 28 | $1,752 | $1,752 | $126.29 | $494.05 | $1,752 |
| CT lumbar spine without contrast | CPT | 72131 | 28 | $1,740 | $1,740 | $126.29 | $494.05 | $1,740 |
| MRI cervical spine without contrast | CPT | 72141 | 28 | $3,889 | $3,889 | $287.06 | $891 | $3,889 |
| MRI thoracic spine without contrast | CPT | 72146 | 28 | $2,335 | $2,335 | $287.06 | $891 | $2,335 |
| MRI lumbar spine without contrast | CPT | 72148 | 30 | $3,889 | $3,889 | $151.98 | $891 | $3,889 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 28 | $4,064 | $4,064 | $423.28 | $1,260.68 | $4,064 |
| MRI cervical spine with and without contrast | CPT | 72156 | 28 | $5,352 | $5,352 | $423.28 | $1,406 | $5,352 |
| MRI lumbar spine with contrast | CPT | 72158 | 28 | $5,352 | $5,352 | $423.28 | $1,406 | $5,352 |
| CT pelvis without contrast | CPT | 72192 | 28 | $2,466 | $2,466 | $126.29 | $494.05 | $2,466 |
| CT pelvis with contrast | CPT | 72193 | 28 | $3,607 | $3,607 | $211.41 | $680.81 | $3,607 |
| Shoulder X-ray | CPT | 73030 | 31 | $910 | $910 | $26.05 | $112.98 | $680.81 |
| Humerus X-ray | CPT | 73060 | 31 | $325 | $325 | $26.05 | $111.93 | $680.81 |
| Hand X-ray 3 views | CPT | 73130 | 31 | $520 | $520 | $26.84 | $113.91 | $680.81 |
| MRI upper extremity joint without contrast | CPT | 73221 | 28 | $3,100 | $3,100 | $287.06 | $891 | $3,100 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 28 | $3,211 | $3,211 | $423.28 | $1,393.6 | $3,211 |
| Knee X-ray 1-2 views | CPT | 73560 | 32 | $108,528 | $108,528 | $7.59 | $132.12 | $26,496 |
| Ankle X-ray 3 views | CPT | 73610 | 31 | $550 | $550 | $26.84 | $113.91 | $680.81 |
| MRI lower extremity joint without contrast | CPT | 73721 | 28 | $3,889 | $3,889 | $287.06 | $891 | $3,889 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 28 | $4,405 | $4,405 | $423.28 | $1,406 | $4,405 |
| CT abdomen without contrast | CPT | 74150 | 28 | $2,781 | $2,781 | $126.29 | $494.05 | $2,781 |
| CT abdomen with contrast | CPT | 74160 | 28 | $3,332 | $3,332 | $211.41 | $680.81 | $3,332 |
| CT abdomen with and without contrast | CPT | 74170 | 28 | $4,717 | $4,717 | $211.41 | $685.17 | $4,717 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 28 | $3,478 | $3,478 | $287.06 | $309.76 | $3,478 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 28 | $4,791.35 | $4,791.35 | $418.11 | $444.45 | $4,166 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 28 | $4,717 | $4,717 | $423.28 | $1,694.52 | $4,717 |
| MRI abdomen without contrast | CPT | 74181 | 28 | $3,100 | $3,100 | $287.06 | $891 | $3,100 |
| MRI abdomen with and without contrast | CPT | 74183 | 28 | $4,006 | $4,006 | $423.28 | $1,406 | $4,006 |
| Abdominal ultrasound complete | CPT | 76700 | 28 | $1,608 | $1,608 | $111.92 | $207.4 | $1,608 |
| Abdominal ultrasound limited | CPT | 76705 | 28 | $1,678 | $1,678 | $84.33 | $135.72 | $1,327 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 28 | $1,379 | $1,379 | $110.08 | $135.72 | $1,379 |
| Obstetric ultrasound first trimester | CPT | 76801 | 29 | $507 | $507 | $101.64 | $207.4 | $680.81 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 29 | $1,028 | $1,028 | $114.99 | $207.4 | $1,028 |
| Transvaginal ultrasound | CPT | 76830 | 30 | $2,808 | $2,808 | $66.59 | $135.72 | $1,059 |
| Pelvic ultrasound complete | CPT | 76856 | 29 | $2,662 | $2,662 | $16.39 | $133.19 | $1,471 |
| Scrotal ultrasound | CPT | 76870 | 28 | $1,045 | $1,045 | $97.82 | $207.4 | $1,045 |
| Diagnostic mammography unilateral | CPT | 77065 | 31 | $15,465 | $15,465 | $90.09 | $270.01 | $1,572.96 |
| Diagnostic mammography bilateral | CPT | 77066 | 31 | $717 | $717 | $114.8 | $375.86 | $749.21 |
| Screening mammography bilateral | CPT | 77067 | 31 | $708 | $708 | $47.49 | $285.53 | $928.37 |
| EKG tracing only | CPT | 93005 | 31 | $190 | $190 | $61.35 | $129.35 | $680.81 |
| Transthoracic echocardiogram complete | CPT | 93306 | 31 | $2,064 | $2,064 | $523.81 | $1,132.78 | $2,064 |
| Transthoracic echocardiogram | CPT | 93307 | 31 | $1,329 | $1,329 | $171.21 | $778 | $1,367.1 |
| inpatient | ||||||||
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 19 | $30,806 | $30,806 | $1,252.6 | $18,854 | $26,263 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 19 | $23,937 | $23,937 | $1,252.6 | $9,662.92 | $13,460 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 19 | $22,808 | $22,808 | $1,252.6 | $6,669.78 | $9,291 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 19 | $24,097 | $24,097 | $1,252.6 | $14,736 | $20,528 |
| COPD w MCC | MS-DRG | 190 | 19 | $17,086 | $17,086 | $1,252.6 | $10,558 | $14,707 |
| COPD w CC | MS-DRG | 191 | 19 | $18,023 | $18,023 | $1,252.6 | $8,126.39 | $11,320 |
| COPD w/o CC/MCC | MS-DRG | 192 | 19 | $11,953 | $11,953 | $1,252.6 | $6,280.36 | $8,748.54 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 20 | $30,000 | $30,000 | $1,252.6 | $8,174.94 | $44,605 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 19 | $10,242 | $10,242 | $1,252.6 | $6,156.38 | $8,575.84 |
| AMI discharged alive w MCC | MS-DRG | 280 | 20 | $47,172 | $47,172 | $1,252.6 | $15,872 | $67,542 |
| AMI discharged alive w CC | MS-DRG | 281 | 19 | $24,698 | $24,698 | $1,252.6 | $8,825.31 | $12,294 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 19 | $31,848 | $31,848 | $1,252.6 | $7,376.47 | $31,686 |
| Heart failure & shock w MCC | MS-DRG | 291 | 19 | $21,613 | $21,613 | $1,252.6 | $12,175 | $16,960 |
| Heart failure & shock w CC | MS-DRG | 292 | 19 | $12,715 | $12,715 | $1,252.6 | $8,181.5 | $11,397 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 20 | $66,134 | $66,134 | $1,252.6 | $11,946 | $41,996 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 19 | $16,646 | $16,646 | $1,252.6 | $7,140.92 | $9,947.3 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 19 | $8,854.49 | $8,854.49 | $1,252.6 | $5,826.95 | $7,777.52 |
| GI hemorrhage w CC | MS-DRG | 378 | 19 | $18,274 | $18,274 | $1,252.6 | $9,803.84 | $13,082 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 19 | $17,834 | $17,834 | $1,252.6 | $7,874.86 | $10,820 |
| Kidney/UTI w MCC | MS-DRG | 689 | 19 | $21,190 | $21,190 | $1,252.6 | $11,041 | $15,379 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 19 | $15,394 | $15,394 | $1,252.6 | $7,818.72 | $10,891 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 19 | $30,957 | $30,957 | $1,252.6 | $18,225 | $25,387 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 19 | $22,643 | $22,643 | $1,252.6 | $9,782.32 | $13,627 |
| lab | ||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 31 | $102 | $102 | $8.46 | $58.43 | $680.81 |
| Electrolyte panel | CPT | 80051 | 31 | $72 | $72 | $6.18 | $18.02 | $680.81 |
| Comprehensive metabolic panel | CPT | 80053 | 31 | $178 | $178 | $10.56 | $120.12 | $680.81 |
| Lipid panel | CPT | 80061 | 32 | $233 | $233 | $11.81 | $62.46 | $680.81 |
| Renal function panel | CPT | 80069 | 31 | $166 | $166 | $7.65 | $22.04 | $680.81 |
| Hepatic function panel | CPT | 80076 | 31 | $134 | $134 | $7.2 | $20.7 | $680.81 |
| Urinalysis non-automated | CPT | 81002 | 32 | $7.49 | $7.49 | $2.62 | $4.87 | $680.81 |
| Urinalysis automated | CPT | 81003 | 32 | $32 | $32 | $1.98 | $12.83 | $680.81 |
| Glucose quantitative | CPT | 82947 | 32 | $52 | $52 | $3.47 | $21.78 | $680.81 |
| Hemoglobin A1c | CPT | 83036 | 32 | $168 | $168 | $8.56 | $16.52 | $680.81 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 32 | $321 | $321 | $14.82 | $28.58 | $680.81 |
| Complete blood count with automated differential | CPT | 85025 | 32 | $56 | $56 | $6.85 | $13.22 | $680.81 |
| Complete blood count without differential | CPT | 85027 | 32 | $56 | $56 | $5.71 | $11.01 | $680.81 |
| Urine culture bacterial | CPT | 87086 | 32 | $111 | $111 | $7.12 | $13.73 | $680.81 |
| Urine culture identification | CPT | 87088 | 32 | $69.1 | $69.1 | $7.13 | $39.57 | $680.81 |
| Tissue exam by pathologist level IV | CPT | 88305 | 31 | $557 | $557 | $27.79 | $130.36 | $680.81 |
| maternity | ||||||||
| Vaginal delivery only | CPT | 59409 | 21 | $9,141 | $9,141 | $680.81 | $6,731.43 | $9,141 |
| Vaginal delivery w complicating dx | MS-DRG | 774 | 1 | $25,328 | $25,328 | $9,470.17 | $10,180 | $10,891 |
| Vaginal delivery w/o complicating dx | MS-DRG | 775 | 1 | $18,147 | $18,147 | $8,903.04 | $13,560 | $25,400 |
| office | ||||||||
| Office visit, new patient, 15-29 min | CPT | 99202 | 27 | $272 | $272 | $46.12 | $169.61 | $680.81 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 27 | $349 | $349 | $80.43 | $209.32 | $680.81 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 27 | $564 | $564 | $150.71 | $169.61 | $680.81 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 27 | $1,007 | $1,007 | $153.04 | $523.64 | $1,007 |
| Office visit, established patient, 5 min | CPT | 99211 | 30 | $226 | $226 | $8.58 | $70 | $680.81 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 30 | $346 | $346 | $34.61 | $167.21 | $680.81 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 30 | $494 | $494 | $42.29 | $271.41 | $680.81 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 30 | $444 | $444 | $58.25 | $168.57 | $680.81 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 30 | $582 | $582 | $62.97 | $315.9 | $680.81 |
| preventive | ||||||||
| Upper GI endoscopy diagnostic | CPT | 43235 | 31 | $7,342.66 | $7,342.66 | $111.82 | $1,141.32 | $1,975 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 31 | $9,769.19 | $9,769.19 | $55.91 | $1,155.45 | $3,960.23 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 31 | $2,948.22 | $2,948.22 | $47 | $992 | $1,919.24 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 31 | $6,055.27 | $6,055.27 | $55.58 | $1,114.51 | $1,919.24 |
| Colonoscopy diagnostic | CPT | 45378 | 32 | $10,584 | $10,584 | $7.59 | $1,165.76 | $2,961 |
| Colonoscopy with biopsy | CPT | 45380 | 31 | $9,786.37 | $9,786.37 | $2.89 | $1,505.82 | $2,961 |
| Colonoscopy with polyp removal | CPT | 45385 | 31 | $10,998 | $10,998 | $27.79 | $1,505.82 | $2,961 |
| surgery | ||||||||
| Total shoulder arthroplasty | CPT | 23472 | 17 | $67,938 | $67,938 | $165.98 | $21,556 | $36,186 |
| PCI w drug-eluting stent w MCC | MS-DRG | 246 | 1 | $22,440 | $22,440 | $27,600 | $29,670 | $31,740 |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 1 | $18,766 | $18,766 | $11,565 | $14,393 | $17,809 |
| Total hip replacement | CPT | 27130 | 16 | $57,660 | $57,660 | $201.75 | $15,577 | $26,496 |
| Total knee replacement | CPT | 27447 | 18 | $82,727 | $82,727 | $2.89 | $15,577 | $26,496 |
| Knee revision arthroplasty single component | CPT | 27486 | 16 | $137,542 | $137,542 | $201.75 | $15,577 | $26,496 |
| Knee revision arthroplasty all components | CPT | 27487 | 16 | $228,600 | $228,600 | $201.75 | $21,273 | $36,186 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 19 | $29,115 | $29,115 | $2.89 | $4,608.51 | $14,975 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 20 | $113,056 | $113,056 | $2.89 | $4,969.26 | $14,975 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 19 | $46,656 | $46,656 | $2.89 | $4,247.75 | $26,496 |
| ACL reconstruction | CPT | 29888 | 20 | $152,188 | $152,188 | $7.59 | $9,244.03 | $26,496 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 18 | $107,349 | $107,349 | $1,252.6 | $43,543 | $59,341 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 19 | $63,832 | $63,832 | $1,252.6 | $22,401 | $31,204 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 19 | $46,438 | $46,438 | $1,252.6 | $15,840 | $22,065 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 19 | $51,236 | $51,236 | $1,252.6 | $15,920 | $22,177 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 19 | $33,032 | $33,032 | $1,252.6 | $12,928 | $18,009 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 1 | $23,415 | $23,415 | $11,159 | $14,468 | $23,541 |
| Laparoscopic appendectomy | CPT | 44970 | 18 | $27,796 | $27,796 | $506 | $7,334.93 | $12,477 |
| Major joint replacement w MCC | MS-DRG | 469 | 1 | $43,828 | $43,828 | $15,292 | $26,335 | $55,252 |
| Laparoscopic cholecystectomy | CPT | 47562 | 19 | $21,055 | $21,055 | $25.11 | $7,334.93 | $12,477 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 19 | $28,066 | $28,066 | $2.89 | $7,334.93 | $12,477 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 19 | $61,300 | $61,300 | $1,252.6 | $27,131 | $37,794 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 19 | $58,456 | $58,456 | $1,252.6 | $19,621 | $27,331 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 19 | $36,433 | $36,433 | $1,252.6 | $15,364 | $21,401 |
| Lap inguinal hernia repair | CPT | 49650 | 19 | $30,966 | $30,966 | $2.89 | $7,578.45 | $12,477 |
| Lap salpingo-oophorectomy | CPT | 58661 | 20 | $20,783 | $20,783 | $7.59 | $7,640.07 | $12,477 |
| Complex cataract surgery | CPT | 66982 | 18 | $22,837 | $22,837 | $2.89 | $2,800.04 | $4,762.87 |
| Cataract surgery with lens implant | CPT | 66984 | 17 | $21,012 | $21,012 | $680.81 | $2,800.04 | $4,762.87 |
Payer mix (top 30)
| Payer | Codes covered | Median rate |
|---|---|---|
| Cigna | 151 | $423.28 |
| Aetna | 151 | $362.5 |
| Blue Cross Blue Shield | 151 | $437.33 |
| hsno/free care [10801] | 151 | $680.81 |
| UnitedHealthcare | 151 | $452.91 |
| senior whole health [10110] | 146 | $452.91 |
| institution [10406] | 143 | $289.49 |
| fallon mcr [10105] | 141 | $303.97 |
| mgb mcr [10124] | 141 | $289.49 |
| tufts mcr [10112] | 141 | $303.97 |
| tufts connectorcare [10507] | 141 | $492.43 |
| fallon mcr supp [20202] | 141 | $303.97 |
| commonwealth care alliance [10103] | 141 | $313.52 |
| wellpoint [11112] | 138 | $627.22 |
| fallon mcaid carelon hlth [29] | 135 | $1,252.97 |
| fallon carelon hlth [28] | 135 | $1,252.6 |
| hne [11108] | 131 | $1,343.25 |
| CHAMPVA | 114 | $159.71 |
| Medicaid | 113 | $16.39 |
| tufts us family [11203] | 109 | $212.81 |
| workers compensation [20501] | 103 | $243.66 |
| connecticare [11105] | 103 | $668 |
| evernorth behavioral health [27] | 103 | $534.4 |
| First Health | 103 | $501 |
| grants [20507] | 103 | $606.5 |
| hp optum bh [32] | 103 | $668 |
| masshealth mcd mbhp [38] | 103 | $668 |
| wellsense mcaid carelon hlth [21] | 103 | $583.5 |
| fallon connectorcare [10503] | 98 | $711.93 |
| tufts [11201] | 93 | $400.89 |