Mark A. Monaco
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD
Position by payer
Your median contracted rate vs the local peer median, per payer, for every payer we can score in Philadelphia-Camden-Wilmington, PA-NJ-DE-MD. Where a Blue Cross entity's label carries a state, that state names the file we found the rate in, not this practice's location — Blue Cross plans file separately per state and do not share rates, even for the same provider.
| Payer | Codes | Your median | Local peer median | Gap | RateScore |
|---|---|---|---|---|---|
| Highmark Blue Shield (PA file) | 5 | $135.27 | $91.85 | +$43.42 | 754 |
| Aetna | 2 | $74.00 | $38.25 | +$35.75 | 771 |
Documented reimbursement opportunity
The largest per-encounter gaps to the local P90 target, code by code. Modeled from published rates, not guaranteed — per encounter, not annualized.
| Payer | CPT | Your rate | Local median | Local P90 | Per-encounter gap | Peers |
|---|---|---|---|---|---|---|
| Highmark Blue Shield (PA file) | 99213 | $144.85 | $91.85 | $152.58 | $7.73 | 1170 |
| Aetna | 99490 | $99.03 | $49.28 | $105.40 | $6.37 | 97 |
| Highmark Blue Shield (PA file) | 99214 | $211.61 | $165.66 | $214.64 | $3.03 | 1390 |
| Highmark Blue Shield (PA file) | 90662 | $135.27 | $94.53 | $137.21 | $1.94 | 90 |
| Highmark Blue Shield (PA file) | 90480 | $75.95 | $45.28 | $77.04 | $1.09 | 51 |
| Highmark Blue Shield (PA file) | 93000 | $23.61 | $15.17 | $23.95 | $0.34 | 269 |
What insurers pay nationally for these codes: 99213 · 99214 · 93000
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