Individual Comprehensive Psychotherapy
|
Facility
|
OP
|
$0.28
|
|
Service Code
|
EAPG 00316
|
Min. Negotiated Rate |
$0.28 |
Max. Negotiated Rate |
$0.28 |
Rate for Payer: Sunshine Health Medicaid |
$0.28
|
|
Individual Therapy
|
Professional
|
Both
|
$42.00
|
|
Service Code
|
CPT 90837 GT
|
Hospital Charge Code |
2390837
|
Min. Negotiated Rate |
$121.79 |
Max. Negotiated Rate |
$235.96 |
Rate for Payer: Aetna Better Health CHIP/Medicaid |
$127.88
|
Rate for Payer: Humana Commercial |
$164.02
|
Rate for Payer: Humana Commercial |
$140.59
|
Rate for Payer: Humana Commercial |
$152.31
|
Rate for Payer: Humana Medicare |
$164.02
|
Rate for Payer: Humana Medicare |
$152.31
|
Rate for Payer: Humana Medicare |
$140.59
|
Rate for Payer: Magellan Medicaid |
$121.79
|
Rate for Payer: Prime Health Services Workers Comp |
$235.96
|
|
Individual Therapy
|
Professional
|
Both
|
$42.00
|
|
Service Code
|
CPT 90832 GT
|
Hospital Charge Code |
2190832
|
Min. Negotiated Rate |
$40.00 |
Max. Negotiated Rate |
$121.42 |
Rate for Payer: Aetna Better Health CHIP/Medicaid |
$65.42
|
Rate for Payer: Carelon Commercial/Medicare |
$40.00
|
Rate for Payer: Carelon Commercial/Medicare |
$45.00
|
Rate for Payer: Humana Commercial |
$74.05
|
Rate for Payer: Humana Commercial |
$86.38
|
Rate for Payer: Humana Commercial |
$80.21
|
Rate for Payer: Humana Medicare |
$86.38
|
Rate for Payer: Humana Medicare |
$74.05
|
Rate for Payer: Humana Medicare |
$80.21
|
Rate for Payer: Magellan Medicaid |
$62.30
|
Rate for Payer: Prime Health Services Workers Comp |
$121.42
|
|
Individual Therapy
|
Professional
|
Both
|
$42.00
|
|
Service Code
|
CPT 90834 GT
|
Hospital Charge Code |
2290834
|
Min. Negotiated Rate |
$55.00 |
Max. Negotiated Rate |
$160.02 |
Rate for Payer: Aetna Better Health CHIP/Medicaid |
$86.32
|
Rate for Payer: Carelon Commercial/Medicare |
$60.00
|
Rate for Payer: Carelon Commercial/Medicare |
$55.00
|
Rate for Payer: Humana Commercial |
$95.86
|
Rate for Payer: Humana Commercial |
$103.84
|
Rate for Payer: Humana Commercial |
$111.83
|
Rate for Payer: Humana Medicare |
$103.84
|
Rate for Payer: Humana Medicare |
$95.86
|
Rate for Payer: Humana Medicare |
$111.83
|
Rate for Payer: Magellan Medicaid |
$82.21
|
Rate for Payer: Prime Health Services Workers Comp |
$160.02
|
|
Infections Of Upper Respiratory Tract And Otitis Media
|
Facility
|
OP
|
$0.36
|
|
Service Code
|
EAPG 00562
|
Min. Negotiated Rate |
$0.36 |
Max. Negotiated Rate |
$0.36 |
Rate for Payer: Sunshine Health Medicaid |
$0.36
|
|
Inflammatory Bowel Disease
|
Facility
|
OP
|
$0.28
|
|
Service Code
|
EAPG 00626
|
Min. Negotiated Rate |
$0.28 |
Max. Negotiated Rate |
$0.28 |
Rate for Payer: Sunshine Health Medicaid |
$0.28
|
|
Inguinal, Femoral And Umbilical Hernia Repair
|
Facility
|
OP
|
$8.12
|
|
Service Code
|
EAPG 03033
|
Min. Negotiated Rate |
$8.12 |
Max. Negotiated Rate |
$8.12 |
Rate for Payer: Sunshine Health Medicaid |
$8.12
|
|
Injection(S) For Radiological Imaging
|
Facility
|
OP
|
$0.76
|
|
Service Code
|
EAPG 00278
|
Min. Negotiated Rate |
$0.76 |
Max. Negotiated Rate |
$0.76 |
Rate for Payer: Sunshine Health Medicaid |
$0.76
|
|
Inpatient Room & Board-Detoxification
|
Facility
|
IP
|
$1,200.00
|
|
Hospital Charge Code |
3126
|
Hospital Revenue Code
|
126
|
Min. Negotiated Rate |
$359.76 |
Max. Negotiated Rate |
$990.00 |
Rate for Payer: Behavioral Services Network Medicaid |
$850.00
|
Rate for Payer: Carelon Commercial/Medicare |
$700.00
|
Rate for Payer: Carelon Medicaid |
$700.00
|
Rate for Payer: Cigna/Evernorth Commercial |
$711.00
|
Rate for Payer: Lucet Commercial |
$748.00
|
Rate for Payer: Magellan Medicaid |
$700.00
|
Rate for Payer: Prime Health Services Workers Comp |
$359.76
|
Rate for Payer: Sunshine Health Medicaid |
$784.00
|
Rate for Payer: Sunshine Health Medicare |
$784.00
|
Rate for Payer: United Behavioral Health Care/Optum Commercial |
$990.00
|
Rate for Payer: United Behavioral Health Care/Optum Medicaid |
$743.00
|
|
Inpatient Room & Board-Psychiatric
|
Facility
|
IP
|
$1,200.00
|
|
Hospital Charge Code |
2124
|
Hospital Revenue Code
|
124
|
Min. Negotiated Rate |
$359.76 |
Max. Negotiated Rate |
$1,100.00 |
Rate for Payer: Aetna Commercial |
$714.00
|
Rate for Payer: Aetna Medicare |
$714.00
|
Rate for Payer: Behavioral Services Network Medicaid |
$850.00
|
Rate for Payer: Carelon Commercial/Medicare |
$700.00
|
Rate for Payer: Carelon Medicaid |
$700.00
|
Rate for Payer: Cigna/Evernorth Commercial |
$711.00
|
Rate for Payer: Humana Commercial |
$646.00
|
Rate for Payer: Lucet Commercial |
$748.00
|
Rate for Payer: Magellan Medicaid |
$700.00
|
Rate for Payer: Molina Complete Care CHIP/Medicaid |
$850.00
|
Rate for Payer: Molina Complete Care Marketplace |
$850.00
|
Rate for Payer: Molina Complete Care Medicare |
$850.00
|
Rate for Payer: Prime Health Services Workers Comp |
$359.76
|
Rate for Payer: Sunshine Health Medicaid |
$784.00
|
Rate for Payer: Sunshine Health Medicare |
$784.00
|
Rate for Payer: Tricare Military (Humana Behavioral Health) Tricare |
$790.30
|
Rate for Payer: United Behavioral Health Care/Optum Commercial |
$1,100.00
|
Rate for Payer: United Behavioral Health Care/Optum Medicaid |
$825.00
|
|
Insertion Of Penile Prosthesis
|
Facility
|
OP
|
$28.12
|
|
Service Code
|
EAPG 00182
|
Min. Negotiated Rate |
$28.12 |
Max. Negotiated Rate |
$28.12 |
Rate for Payer: Sunshine Health Medicaid |
$28.12
|
|
Intellectual Disability
|
Facility
|
OP
|
$0.30
|
|
Service Code
|
EAPG 00828
|
Min. Negotiated Rate |
$0.30 |
Max. Negotiated Rate |
$0.30 |
Rate for Payer: Sunshine Health Medicaid |
$0.30
|
|
Intensive Outpatient Psychiatric Treatment
|
Facility
|
OP
|
$0.68
|
|
Service Code
|
EAPG 00327
|
Min. Negotiated Rate |
$0.68 |
Max. Negotiated Rate |
$0.68 |
Rate for Payer: Sunshine Health Medicaid |
$0.68
|
|
Intensive Team Case Management
|
Professional
|
Both
|
$36.00
|
|
Service Code
|
CPT T1017 HK
|
Hospital Charge Code |
96T1017
|
Min. Negotiated Rate |
$12.00 |
Max. Negotiated Rate |
$12.07 |
Rate for Payer: Carelon Medicaid |
$12.00
|
Rate for Payer: Molina Complete Care Marketplace |
$12.07
|
|
Intentional Self-Harm And Attempted Suicide
|
Facility
|
OP
|
$1.06
|
|
Service Code
|
EAPG 00832
|
Min. Negotiated Rate |
$1.06 |
Max. Negotiated Rate |
$1.06 |
Rate for Payer: Sunshine Health Medicaid |
$1.06
|
|
Interactive Complexity
|
Professional
|
Both
|
$60.00
|
|
Service Code
|
CPT 90785
|
Hospital Charge Code |
1890785
|
Min. Negotiated Rate |
$5.80 |
Max. Negotiated Rate |
$22.74 |
Rate for Payer: Aetna Better Health CHIP/Medicaid |
$6.21
|
Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$12.37
|
Rate for Payer: Behavioral Services Network Commercial |
$13.61
|
Rate for Payer: Behavioral Services Network Medicare |
$12.37
|
Rate for Payer: Carelon Medicare |
$12.37
|
Rate for Payer: Humana Commercial |
$5.80
|
Rate for Payer: Humana Commercial |
$6.29
|
Rate for Payer: Humana Commercial |
$6.76
|
Rate for Payer: Humana Medicare |
$6.29
|
Rate for Payer: Humana Medicare |
$5.80
|
Rate for Payer: Humana Medicare |
$6.76
|
Rate for Payer: Lucet Commercial |
$9.90
|
Rate for Payer: Lucet Commercial |
$11.13
|
Rate for Payer: Lucet Commercial |
$11.75
|
Rate for Payer: Magellan Medicaid |
$5.91
|
Rate for Payer: Molina Complete Care Medicaid/Medicare |
$12.37
|
Rate for Payer: Prime Health Services Workers Comp |
$22.74
|
|
Intermediate Wound Repair And Treatment
|
Facility
|
OP
|
$0.82
|
|
Service Code
|
EAPG 00017
|
Min. Negotiated Rate |
$0.82 |
Max. Negotiated Rate |
$0.82 |
Rate for Payer: Sunshine Health Medicaid |
$0.82
|
|
Interstitial And Alveolar Lung Diagnoses
|
Facility
|
OP
|
$0.41
|
|
Service Code
|
EAPG 00582
|
Min. Negotiated Rate |
$0.41 |
Max. Negotiated Rate |
$0.41 |
Rate for Payer: Sunshine Health Medicaid |
$0.41
|
|
Intestinal Obstruction Diagnoses
|
Facility
|
OP
|
$0.64
|
|
Service Code
|
EAPG 00618
|
Min. Negotiated Rate |
$0.64 |
Max. Negotiated Rate |
$0.64 |
Rate for Payer: Sunshine Health Medicaid |
$0.64
|
|
Intracranial Hemorrhage
|
Facility
|
OP
|
$0.58
|
|
Service Code
|
EAPG 00539
|
Min. Negotiated Rate |
$0.58 |
Max. Negotiated Rate |
$0.58 |
Rate for Payer: Sunshine Health Medicaid |
$0.58
|
|
Intraoperative, Post-Operative Or Post-Traumatic Infections And Complications
|
Facility
|
OP
|
$0.46
|
|
Service Code
|
EAPG 00806
|
Min. Negotiated Rate |
$0.46 |
Max. Negotiated Rate |
$0.46 |
Rate for Payer: Sunshine Health Medicaid |
$0.46
|
|
IOP Per Diem
|
Professional
|
Both
|
$390.00
|
|
Service Code
|
CPT S9480
|
Hospital Charge Code |
90S9480
|
Min. Negotiated Rate |
$40.18 |
Max. Negotiated Rate |
$46.89 |
Rate for Payer: Humana Commercial |
$43.53
|
Rate for Payer: Humana Commercial |
$40.18
|
Rate for Payer: Humana Commercial |
$46.89
|
|
Irritable Bowel Syndrome
|
Facility
|
OP
|
$0.23
|
|
Service Code
|
EAPG 00632
|
Min. Negotiated Rate |
$0.23 |
Max. Negotiated Rate |
$0.23 |
Rate for Payer: Sunshine Health Medicaid |
$0.23
|
|
Kidney And Urinary Tract Malignancy
|
Facility
|
OP
|
$0.27
|
|
Service Code
|
EAPG 00721
|
Min. Negotiated Rate |
$0.27 |
Max. Negotiated Rate |
$0.27 |
Rate for Payer: Sunshine Health Medicaid |
$0.27
|
|
Kidney Transplant
|
Facility
|
OP
|
$15.78
|
|
Service Code
|
EAPG 03052
|
Min. Negotiated Rate |
$15.78 |
Max. Negotiated Rate |
$15.78 |
Rate for Payer: Sunshine Health Medicaid |
$15.78
|
|