Contracts & Fee Schedules
Manage provider contracts, fee schedules, and capitation rate configurations
Active Contracts
284
Expiring (90d)
18
Fee-for-Service
196
Value-Based
48
Contracts
Fee Schedule
Capitation Rates
Rate Comparison
Contract Registry
| Provider / Group | Type | Effective | Expiry | Status | Actions |
|---|---|---|---|---|---|
| Heart Care Associates | FFS | Jan 1, 2024 | Dec 31, 2024 | Active | |
| Bone & Joint Clinic | Value-Based | Jan 1, 2024 | Dec 31, 2025 | Active | |
| Community Health Center | Capitation | Jul 1, 2023 | Jun 30, 2024 | Expiring Soon | |
| NeuroSpecialists Group | FFS | Jan 1, 2024 | Dec 31, 2024 | Active | |
| Regional Cancer Center | FFS | Apr 1, 2024 | Mar 31, 2025 | Active | |
| GI Specialists LLC | Value-Based | Jan 1, 2024 | Dec 31, 2025 | Active | |
| Behavioral Health Clinic | Capitation | Jan 1, 2024 | Dec 31, 2024 | Active |
Fee Schedule — Cardiology
| CPT Code | Description | Medicare Rate | Contract Rate | vs. Medicare |
|---|---|---|---|---|
| 93000 | ECG w/ interpretation | $26.89 | $29.50 | +9.7% |
| 93306 | Echo w/ Doppler | $189.45 | $210.00 | +10.8% |
| 93510 | Cardiac catheterization | $892.10 | $950.00 | +6.5% |
| 93650 | Ablation — atrial fib | $2,340.00 | $2,100.00 | -10.3% |
| 93017 | Exercise stress test | $98.50 | $112.00 | +13.7% |
| 33249 | ICD placement | $4,120.00 | $4,500.00 | +9.2% |
| 93460 | Right heart cath | $445.30 | $490.00 | +10.0% |
PCP PMPM
$28.50
Specialist PMPM
$14.75
All-Inclusive PMPM
$62.00
Capitation Rate Schedule
| Provider | Plan | PMPM Rate | Member Count | Total Monthly | Effective |
|---|---|---|---|---|---|
| Community Health Center | Plan A — PCP | $28.50 | 4,200 | $119,700 | Jan 1, 2024 |
| Behavioral Health Clinic | Plan A/B — MH | $14.75 | 1,850 | $27,288 | Jan 1, 2024 |
| PACE Provider Network | PACE — Full Risk | $62.00 | 380 | $23,560 | Jul 1, 2023 |
Rate Comparison — vs. Medicare Benchmark
Heart Care Associates
+12%
Bone & Joint Clinic
+8%
Regional Cancer Center
-5%
NeuroSpecialists Group
+15%
GI Specialists LLC
+3%
Rates above 100% Medicare indicate above-Medicare reimbursement. Positive percentages represent plan payments above Medicare benchmark.