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South Carolina 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 $56 · 10th–90th $43–$950%10%20%10th90th$56Professionalmedian $52 · 10th–90th $40–$710%10%20%10th90th$52$50.0$100.0$200.0$500.0

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
Facility
Modifier
Typical Low / Median / Typical High
$47.86 / $47.86 / $60.26
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $51.29 / $69.18
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$58.88 / $58.88 / $58.88
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $63.10
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $125.89 / $213.80
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $69.18 / $93.33
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$41.69 / $53.70 / $70.79
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $676.08
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $61.66 / $93.33