|
23 Hr. Observation Stay
|
Facility
|
IP
|
$900.00
|
|
| Hospital Charge Code |
4762
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$269.82 |
| Max. Negotiated Rate |
$870.00 |
| Rate for Payer: Cigna/Evernorth Commercial |
$720.00
|
| Rate for Payer: Magellan Medicaid |
$770.00
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$870.00
|
| Rate for Payer: Molina Complete Care Marketplace |
$870.00
|
| Rate for Payer: Molina Complete Care Medicare |
$870.00
|
| Rate for Payer: Prime Health Services Workers Comp |
$269.82
|
| Rate for Payer: Sunshine Health Medicaid |
$728.00
|
| Rate for Payer: Sunshine Health Medicare |
$728.00
|
|
|
Abdominal Hernia Repair
|
Facility
|
OP
|
$8.26
|
|
|
Service Code
|
EAPG 03035
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$8.26 |
| Rate for Payer: Sunshine Health Medicaid |
$8.26
|
|
|
Abdominal Pain
|
Facility
|
OP
|
$0.52
|
|
|
Service Code
|
EAPG 00628
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Sunshine Health Medicaid |
$0.52
|
|
|
Abdominal Paracentesis And Related Peritoneal Drainage Procedures
|
Facility
|
OP
|
$1.55
|
|
|
Service Code
|
EAPG 00150
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$1.55 |
| Rate for Payer: Sunshine Health Medicaid |
$1.55
|
|
|
Abortion And Miscarriage Treatment And Procedures
|
Facility
|
OP
|
$3.92
|
|
|
Service Code
|
EAPG 00194
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Sunshine Health Medicaid |
$3.92
|
|
|
Abortion Related Diagnoses
|
Facility
|
OP
|
$0.76
|
|
|
Service Code
|
EAPG 00763
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$0.76 |
| Rate for Payer: Sunshine Health Medicaid |
$0.76
|
|
|
Activity Therapy
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
EAPG 00319
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Sunshine Health Medicaid |
$0.32
|
|
|
Acute And Subacute Endocarditis
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
EAPG 00608
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Sunshine Health Medicaid |
$0.29
|
|
|
Acute Anxiety And Delirium States
|
Facility
|
OP
|
$0.45
|
|
|
Service Code
|
EAPG 00826
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Sunshine Health Medicaid |
$0.45
|
|
|
Acute Bronchitis
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
EAPG 00584
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Sunshine Health Medicaid |
$0.54
|
|
|
Acute Kidney Injury
|
Facility
|
OP
|
$0.69
|
|
|
Service Code
|
EAPG 00729
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Sunshine Health Medicaid |
$0.69
|
|
|
Acute Leukemia
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
EAPG 00800
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Sunshine Health Medicaid |
$0.54
|
|
|
Acute Lower Urinary Tract Infections
|
Facility
|
OP
|
$0.51
|
|
|
Service Code
|
EAPG 00727
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Sunshine Health Medicaid |
$0.51
|
|
|
Acute Major Eye Infections
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
EAPG 00550
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Sunshine Health Medicaid |
$0.29
|
|
|
Acute Myocardial Infarction
|
Facility
|
OP
|
$0.98
|
|
|
Service Code
|
EAPG 00591
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Sunshine Health Medicaid |
$0.98
|
|
|
Adaptive Behavioral Health Treatment Services
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
EAPG 00309
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Sunshine Health Medicaid |
$0.28
|
|
|
Add to CCM initiation visit (care plan formulation)
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT G0506
|
| Hospital Charge Code |
59G0506
|
| Min. Negotiated Rate |
$33.41 |
| Max. Negotiated Rate |
$100.77 |
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$41.76
|
| Rate for Payer: Behavioral Services Network Commercial |
$45.94
|
| Rate for Payer: Behavioral Services Network Medicare |
$41.76
|
| Rate for Payer: Carelon Medicare |
$41.76
|
| Rate for Payer: Lucet Commercial |
$39.67
|
| Rate for Payer: Lucet Commercial |
$33.41
|
| Rate for Payer: Lucet Commercial |
$37.58
|
| Rate for Payer: Molina Complete Care Medicaid/Medicare |
$41.76
|
| Rate for Payer: Prime Health Services Workers Comp |
$100.77
|
|
|
Adjunctive Dental Services
|
Facility
|
OP
|
$0.57
|
|
|
Service Code
|
EAPG 00350
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Sunshine Health Medicaid |
$0.57
|
|
|
Adjustment Disorders And Neuroses Except Depressive Diagnoses
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
EAPG 00825
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Sunshine Health Medicaid |
$0.32
|
|
|
Administer phrophylactic/dx inj
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
3396372
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$21.76 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$11.53
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$13.57
|
| Rate for Payer: Behavioral Services Network Commercial |
$14.93
|
| Rate for Payer: Behavioral Services Network Medicare |
$13.57
|
| Rate for Payer: Carelon Medicare |
$13.57
|
| Rate for Payer: Lucet Commercial |
$12.21
|
| Rate for Payer: Lucet Commercial |
$10.86
|
| Rate for Payer: Lucet Commercial |
$12.89
|
| Rate for Payer: Magellan Medicaid |
$10.98
|
| Rate for Payer: Molina Complete Care Medicaid/Medicare |
$13.57
|
| Rate for Payer: Prime Health Services Workers Comp |
$21.76
|
|
|
Adolescent Intensive Outpatient Program - Substance Abuse
|
Facility
|
OP
|
$330.00
|
|
|
Hospital Revenue Code
|
906
|
| Min. Negotiated Rate |
$227.00 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: United Behavioral Health Care/Optum Commercial |
$330.00
|
| Rate for Payer: United Behavioral Health Care/Optum Medicaid |
$227.00
|
| Rate for Payer: United Behavioral Health Care/Optum Medicare |
$330.00
|
|
|
Adult Intensive Outpatient Program - Substance Abuse
|
Facility
|
OP
|
$275.00
|
|
|
Hospital Revenue Code
|
906
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: United Behavioral Health Care/Optum Commercial |
$275.00
|
| Rate for Payer: United Behavioral Health Care/Optum Medicaid |
$206.00
|
| Rate for Payer: United Behavioral Health Care/Optum Medicare |
$275.00
|
|
|
Adult Preventive Medicine
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
EAPG 00876
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Sunshine Health Medicaid |
$0.33
|
|
|
Advanced Molecular Pathology And Genetic Tests
|
Facility
|
OP
|
$3.79
|
|
|
Service Code
|
EAPG 02045
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Sunshine Health Medicaid |
$3.79
|
|
|
Aftercare, Burns, Corrosions, Other Injuries Related To The Skin And Sub Tis
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
EAPG 00787
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Sunshine Health Medicaid |
$0.26
|
|
