Health plan price transparency helps consumers know the cost of a covered item or service before receiving care. Beginning July 1, 2022 we will begin posting pricing information for covered items and services. Our current carrier, Cigna will host the documents on our behalf. This link leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.
This material is for information only. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional.
- Pricing included in the fee schedule data is accurate as of the date it is pulled from system files and may be subject to change between the date the pricing data is pulled and the next update of the files. This file and the included pricing data is not a guarantee of payment and may not always reflect amounts on final claim processing documentation. Eligibility and benefit determinations are made when the claim is processed by the current carrier of the Sandvine Health and Welfare Plan.
- Rates for codes appearing in the file may vary when a given code rate has a modifier applied or when member benefit or treatment characteristics result in certain rate adjustments. Different codes rates for the same codes may indicate that a modifier or some other type of member benefit or treatment characteristic applies.
- Price transparency requirement can result in very large file sizes which may, in turn, cause issues while downloading them. If you are experiencing problems, please try a different web browser or check your Internet/Wi-Fi speed.