Claude Sirlin
radiology · San Diego-Chula Vista-Carlsbad, CA
Position by payer
Your median contracted rate vs the local peer median, per payer, for every payer we can score in San Diego-Chula Vista-Carlsbad, CA. 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 |
|---|---|---|---|---|---|---|
| Centene | 26 | Local | $183.27 | $196.59 | −$13.32 | 719 |
| Blueshield Ca | 38 | Local | $521.31 | $385.69 | +$135.62 | 735 |
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 |
|---|---|---|---|---|---|---|---|
| Blueshield Ca | 31297 | Local | $7,144.17 | $7,144.17 | $7,554.08 | $409.91 | 10 |
| Centene | 52000 | Local | $152.17 | $257.70 | $451.59 | $299.42 | 5040 |
| Centene | 12001 | Local | $92.38 | $203.11 | $268.25 | $175.87 | 3472 |
| Centene | 31231 | Local | $117.79 | $197.48 | $260.85 | $143.06 | 3997 |
| Centene | 12011 | Local | $117.20 | $220.76 | $220.76 | $103.56 | 2084 |
| Centene | 99284 | Local | $249.02 | $249.02 | $326.10 | $77.08 | 2818 |
| Blueshield Ca | 33207 | Local | $1,767.86 | $1,362.87 | $1,826.99 | $59.13 | 31 |
| Blueshield Ca | 61796 | Local | $1,595.05 | $1,229.65 | $1,648.40 | $53.35 | 29 |
| Blueshield Ca | 20670 | Local | $1,404.86 | $1,083.03 | $1,451.84 | $46.98 | 30 |
| Centene | 62323 | Local | $195.70 | $195.70 | $238.89 | $43.19 | 4347 |
What insurers pay nationally for these codes: 52000 · 12001 · 12011 · 99284 · 62323
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