Michael Alex Sousa
ortho · Missoula, MT
Anthem National is the worst-paying contract we can score for Michael Alex Sousa. 96.2% 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 Missoula, MT. 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 National | 167 | Local | $93.63 | $114.62 | −$20.99 | 321 |
| Centene | 1 | Local | $9.74 | $9.74 | $0.00 | 483 |
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 |
|---|---|---|---|---|---|---|---|
| Anthem National | 45386 | Local | $285.63 | $610.88 | $1,856.98 | $1,571.35 | 25 |
| Anthem National | 52315 | Local | $643.46 | $611.58 | $1,900.80 | $1,257.34 | 19 |
| Anthem National | 27093 | Local | $315.33 | $197.15 | $768.56 | $453.23 | 23 |
| Anthem National | 45385 | Local | $342.29 | $715.09 | $715.09 | $372.80 | 145 |
| Anthem National | 64634 | Local | $90.94 | $403.29 | $403.29 | $312.35 | 90 |
| Anthem National | 95811 | Local | $729.37 | $1,028.99 | $1,028.99 | $299.62 | 147 |
| Anthem National | 64636 | Local | $79.52 | $378.58 | $378.58 | $299.06 | 107 |
| Anthem National | 23472 | Local | $1,984.75 | $2,283.55 | $2,283.55 | $298.80 | 153 |
| Anthem National | 43235 | Local | $165.89 | $453.77 | $453.77 | $287.88 | 146 |
| Anthem National | 95810 | Local | $696.93 | $984.30 | $984.30 | $287.37 | 148 |
What insurers pay nationally for these codes: 45386 · 52315 · 45385 · 64634 · 95811 · 64636 · 23472 · 43235 · 95810
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