PR Coordinated Care Fee Maintenance Rate

Payers reporting HCPCS G9002

Payer pricing summary

Low

Average

$71

Median

$74

High

$130

Payer rate distribution

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#
1	Highmark professional · fee schedule · both · +2 other terms	4	$74	$74	—	—	41–50	$74 – $74
2	Wellmark professional · fee schedule · both · +2 other terms	4	$74	$74	—	—	2–20	$74 – $74
3	Carefirst professional · fee schedule · both · +1 other terms	4	$74	$74	—	—	1–10	$74 – $74
4	Excellus professional · fee schedule · both · +1 other terms	4	$74	$74	—	—	1–10	$74 – $74
5	Premera professional · fee schedule · both · +1 other terms	4	$74	$74	—	—	1–10	$74 – $74
6	Regence professional · fee schedule · both · +1 other terms	4	$74	$74	—	—	1–10	$74 – $74
7	Molina facility · case rate · outpatient · +8 other terms	27	$32	$60	$44	73%	—	$14 – $182
8	Aetna fee schedule · outpatient · +13 other terms	24	$0	$24	$60	250%	—	$0 – $174
9	Blue Cross Blue Shield facility · fee schedule · outpatient · +8 other terms	20	$192	$201	$65	32%	—	$20 – $383
10	UnitedHealthcare facility · case rate · outpatient · +10 other terms	17	$21	$32	$24	74%	—	$14 – $88
11	Anthem facility · case rate · outpatient · +8 other terms	15	$20	$22	$5	23%	—	$13 – $34
12	Caresource facility · case rate · outpatient · +2 other terms	15	$20	$22	$5	23%	—	$13 – $34
13	Optum facility · case rate · outpatient	13	$19	$29	$20	70%	—	$17 – $76
14	Cigna professional · fee schedule · outpatient · +5 other terms	11	$8	$10	$15	141%	—	$5 – $77
15	Medica fee schedule · outpatient · +4 other terms	10	$101	$102	$26	25%	—	$62 – $131
16	Humana fee schedule · outpatient · +9 other terms	9	$0	$81	$90	112%	—	$0 – $183
17	Aetna Better Health fee schedule · inpatient · +3 other terms	7	$0	$0	—	—	—	$0 – $0
18	Amerihealth Caritas facility · case rate · outpatient · +2 other terms	7	$88	$89	$3	3%	—	$88 – $96
19	Medcost professional · percent of total billed charges · bothfrom % of charges · +1 other terms	4	$83	$83	$12	15%	—	$71 – $95
20	Medical Mutual professional · percent of total billed charges · bothfrom % of charges · +1 other terms	4	$83	$83	$12	15%	—	$71 – $95
21	Phcs professional · percent of total billed charges · bothfrom % of charges · +2 other terms	4	$97	$97	$12	12%	—	$85 – $109
22	Tricare professional · percent of total billed charges · bothfrom % of charges · +1 other terms	4	$111	$111	$14	12%	—	$98 – $125
23	First Health professional · fee schedule · both · +6 other terms	3	$0	$0	—	—	—	$0 – $0
24	Medicaid facility · case rate · outpatient	2	$80	$80	—	—	—	$80 – $80
25	Bcbs La facility · fee schedule · outpatient	1	$0	$0	—	—	—	$0 – $0

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