|
Level Iii Vascular Radiological Procedures
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
EAPG 00280
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Sunshine Health Medicaid |
$10.00
|
|
|
Level Ii Joint, Tendon, Or Ligament Injection Procedures
|
Facility
|
OP
|
$0.94
|
|
|
Service Code
|
EAPG 00050
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Sunshine Health Medicaid |
$0.94
|
|
|
Level Ii Kidney And Ureteral Procedures
|
Facility
|
OP
|
$6.05
|
|
|
Service Code
|
EAPG 00171
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$6.05 |
| Rate for Payer: Sunshine Health Medicaid |
$6.05
|
|
|
Level Ii Knee And Lower Leg Procedures
|
Facility
|
OP
|
$15.87
|
|
|
Service Code
|
EAPG 00052
|
| Min. Negotiated Rate |
$15.87 |
| Max. Negotiated Rate |
$15.87 |
| Rate for Payer: Sunshine Health Medicaid |
$15.87
|
|
|
Level Ii Lower Airway Endoscopy
|
Facility
|
OP
|
$8.62
|
|
|
Service Code
|
EAPG 00071
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$8.62 |
| Rate for Payer: Sunshine Health Medicaid |
$8.62
|
|
|
Level Ii Lower Gi Endoscopy
|
Facility
|
OP
|
$4.36
|
|
|
Service Code
|
EAPG 00137
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Sunshine Health Medicaid |
$4.36
|
|
|
Level Ii Mastectomy And Reconstructive Breast Procedures
|
Facility
|
OP
|
$15.80
|
|
|
Service Code
|
EAPG 00022
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$15.80 |
| Rate for Payer: Sunshine Health Medicaid |
$15.80
|
|
|
Level Ii Maxillofacial Prosthetics
|
Facility
|
OP
|
$6.25
|
|
|
Service Code
|
EAPG 00360
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$6.25 |
| Rate for Payer: Sunshine Health Medicaid |
$6.25
|
|
|
Level Ii Microbiology Tests
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
EAPG 00397
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Sunshine Health Medicaid |
$0.09
|
|
|
Level I Immunization
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
EAPG 00414
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Sunshine Health Medicaid |
$0.06
|
|
|
Level I Immunology Tests
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
EAPG 00394
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Sunshine Health Medicaid |
$0.02
|
|
|
Level Ii Nervous System Injections Including Cranial Tap
|
Facility
|
OP
|
$3.11
|
|
|
Service Code
|
EAPG 00220
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$3.11 |
| Rate for Payer: Sunshine Health Medicaid |
$3.11
|
|
|
Level Ii Neurostimulator And Related Device Implantation
|
Facility
|
OP
|
$39.35
|
|
|
Service Code
|
EAPG 00224
|
| Min. Negotiated Rate |
$39.35 |
| Max. Negotiated Rate |
$39.35 |
| Rate for Payer: Sunshine Health Medicaid |
$39.35
|
|
|
Level I Intravitreal, Retinal And Other Posterior Chamber Eye Procedures
|
Facility
|
OP
|
$2.13
|
|
|
Service Code
|
EAPG 00237
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$2.13 |
| Rate for Payer: Sunshine Health Medicaid |
$2.13
|
|
|
Level Ii Opioid Treatment Program Services
|
Facility
|
OP
|
$0.79
|
|
|
Service Code
|
EAPG 04011
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Sunshine Health Medicaid |
$0.79
|
|
|
Level Ii Oral Surgery Procedures
|
Facility
|
OP
|
$4.13
|
|
|
Service Code
|
EAPG 00368
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Sunshine Health Medicaid |
$4.13
|
|
|
Level Ii Orthodontics
|
Facility
|
OP
|
$3.13
|
|
|
Service Code
|
EAPG 00379
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Sunshine Health Medicaid |
$3.13
|
|
|
Level Ii Other Uterine And Adnexa Gynecological Procedures
|
Facility
|
OP
|
$9.27
|
|
|
Service Code
|
EAPG 00208
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$9.27 |
| Rate for Payer: Sunshine Health Medicaid |
$9.27
|
|
|
Level Ii Pathology Tests
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
EAPG 00391
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Sunshine Health Medicaid |
$0.04
|
|
|
Level Ii Penile Procedures
|
Facility
|
OP
|
$6.60
|
|
|
Service Code
|
EAPG 00187
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Sunshine Health Medicaid |
$6.60
|
|
|
Level Ii Percutaneous Coronary And Intracardiac Interventional Procedures
|
Facility
|
OP
|
$29.17
|
|
|
Service Code
|
EAPG 00121
|
| Min. Negotiated Rate |
$29.17 |
| Max. Negotiated Rate |
$29.17 |
| Rate for Payer: Sunshine Health Medicaid |
$29.17
|
|
|
Level Ii Perineal And Vaginal Gynecological Procedures
|
Facility
|
OP
|
$11.69
|
|
|
Service Code
|
EAPG 00189
|
| Min. Negotiated Rate |
$11.69 |
| Max. Negotiated Rate |
$11.69 |
| Rate for Payer: Sunshine Health Medicaid |
$11.69
|
|
|
Level Ii Periodontics
|
Facility
|
OP
|
$2.26
|
|
|
Service Code
|
EAPG 00378
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$2.26 |
| Rate for Payer: Sunshine Health Medicaid |
$2.26
|
|
|
Level Ii Peripheral Endovascular And Transcatheter Procedures
|
Facility
|
OP
|
$14.19
|
|
|
Service Code
|
EAPG 00079
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$14.19 |
| Rate for Payer: Sunshine Health Medicaid |
$14.19
|
|
|
Level Ii Peripheral Nerve Procedures
|
Facility
|
OP
|
$10.78
|
|
|
Service Code
|
EAPG 00218
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$10.78 |
| Rate for Payer: Sunshine Health Medicaid |
$10.78
|
|
