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Arizona rates for HCPCS 99426

Principal care management services, for a single high-risk disease, with the following required elements: one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death, the condition requires development, monitoring, or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen and/or the management of the condition is unusually complex due to comorbidities, ongoing communication and care coordination between relevant practitioners furnishing care; first 30 minutes of clinical staff time directed by physician or other qualified health care professional, per calendar month.

Facilitymedian $54 · 10th–90th $22–$930%10%10th90th$54Professionalmedian $51 · 10th–90th $40–$780%10%20%10th90th$51$10.0$20.0$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $51.29 / $72.44
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $79.43 / $85.11
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$11.22 / $47.86 / $91.20
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $51.29 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $66.07 / $102.33
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.90 / $51.29 / $91.20
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $87.10 / $389.05
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $67.61 / $93.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $64.57 / $104.71