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Maryland 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.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $57.54 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $50.12 / $69.18
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $53.70 / $72.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $67.61 / $114.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $56.23 / $81.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $67.61 / $93.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $66.07 / $104.71
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $93.33 / $109.65