John Gerard Mcmanus
em · Augusta-Richmond County, GA-SC
Anthem Blue Cross Blue Shield (GA file) is the worst-paying contract we can score for John Gerard Mcmanus. 80.5% of local peers, paid by the same payer for the same codes in the same metro, are paid more. That is the payer's pricing decision, not a reflection on this provider.
Position by payer
Your median contracted rate vs the local peer median, per payer, for every payer we can score in Augusta-Richmond County, GA-SC. 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 | Basis | Your median | Local peer median | Gap | RateScore |
|---|---|---|---|---|---|---|
| Anthem Blue Cross Blue Shield (GA file) | 4 | Local | $149.69 | $206.75 | −$57.06 | 407 |
| Centene | 37 | Local | $76.68 | $92.32 | −$15.64 | 466 |
| Aetna | 1 | Local | $595.31 | $595.31 | $0.00 | 600 |
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 | Basis | Your rate | Local peer median | Local P90 | Per-encounter gap | Peers |
|---|---|---|---|---|---|---|---|
| Centene | 95811 | Local | $643.29 | $1,155.38 | $1,230.16 | $586.87 | 704 |
| Centene | 95810 | Local | $612.34 | $879.27 | $1,170.98 | $558.64 | 699 |
| Centene | 95819 | Local | $443.81 | $627.27 | $937.51 | $493.70 | 794 |
| Centene | 95816 | Local | $381.11 | $534.29 | $803.70 | $422.59 | 803 |
| Anthem Blue Cross Blue Shield (GA file) | 99291 | Local | $214.48 | $420.86 | $474.12 | $259.64 | 50 |
| Centene | 90792 | Local | $140.04 | $234.26 | $391.16 | $251.12 | 591 |
| Centene | 12011 | Local | $45.38 | $121.56 | $273.11 | $227.73 | 652 |
| Centene | 52310 | Local | $307.83 | $388.35 | $535.16 | $227.33 | 887 |
| Centene | 12001 | Local | $37.48 | $92.32 | $222.74 | $185.26 | 776 |
| Anthem Blue Cross Blue Shield (GA file) | 99285 | Local | $177.10 | $177.10 | $343.24 | $166.14 | 21 |
What insurers pay nationally for these codes: 95811 · 95810 · 95819 · 95816 · 99291 · 90792 · 12011 · 52310 · 12001 · 99285
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