|
Level I Nervous System Injections Including Cranial Tap
|
Facility
|
OP
|
$0.85
|
|
|
Service Code
|
EAPG 00214
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Sunshine Health Medicaid |
$0.85
|
|
|
Level I Neurostimulator And Related Device Implantation
|
Facility
|
OP
|
$12.63
|
|
|
Service Code
|
EAPG 00223
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$12.63 |
| Rate for Payer: Sunshine Health Medicaid |
$12.63
|
|
|
Level I Opioid Treatment Program Services
|
Facility
|
OP
|
$0.43
|
|
|
Service Code
|
EAPG 04010
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Sunshine Health Medicaid |
$0.43
|
|
|
Level I Oral Surgery Procedures
|
Facility
|
OP
|
$2.89
|
|
|
Service Code
|
EAPG 00367
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Sunshine Health Medicaid |
$2.89
|
|
|
Level I Orthodontics
|
Facility
|
OP
|
$2.84
|
|
|
Service Code
|
EAPG 00371
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Sunshine Health Medicaid |
$2.84
|
|
|
Level I Other Uterine And Adnexa Gynecological Procedures
|
Facility
|
OP
|
$5.08
|
|
|
Service Code
|
EAPG 00207
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$5.08 |
| Rate for Payer: Sunshine Health Medicaid |
$5.08
|
|
|
Level I Pathology Tests
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
EAPG 00390
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Sunshine Health Medicaid |
$0.01
|
|
|
Level I Penile Procedures
|
Facility
|
OP
|
$4.29
|
|
|
Service Code
|
EAPG 00183
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Sunshine Health Medicaid |
$4.29
|
|
|
Level I Percutaneous Coronary And Intracardiac Interventional Procedures
|
Facility
|
OP
|
$18.10
|
|
|
Service Code
|
EAPG 00099
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$18.10 |
| Rate for Payer: Sunshine Health Medicaid |
$18.10
|
|
|
Level I Perineal And Vaginal Gynecological Procedures
|
Facility
|
OP
|
$5.37
|
|
|
Service Code
|
EAPG 00188
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$5.37 |
| Rate for Payer: Sunshine Health Medicaid |
$5.37
|
|
|
Level I Periodontics
|
Facility
|
OP
|
$2.15
|
|
|
Service Code
|
EAPG 00352
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$2.15 |
| Rate for Payer: Sunshine Health Medicaid |
$2.15
|
|
|
Level I Peripheral Endovascular And Transcatheter Procedures
|
Facility
|
OP
|
$8.26
|
|
|
Service Code
|
EAPG 00077
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$8.26 |
| Rate for Payer: Sunshine Health Medicaid |
$8.26
|
|
|
Level I Peripheral Nerve Procedures
|
Facility
|
OP
|
$2.85
|
|
|
Service Code
|
EAPG 00217
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Sunshine Health Medicaid |
$2.85
|
|
|
Level I Peripheral Vascular Repair, Ligation Or Reconstruction
|
Facility
|
OP
|
$4.51
|
|
|
Service Code
|
EAPG 00078
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Sunshine Health Medicaid |
$4.51
|
|
|
Level I Prostate Procedures
|
Facility
|
OP
|
$3.56
|
|
|
Service Code
|
EAPG 00176
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Sunshine Health Medicaid |
$3.56
|
|
|
Level I Prosthodontics, Fixed
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
EAPG 00353
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Sunshine Health Medicaid |
$0.22
|
|
|
Level I Prosthodontics, Removable
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
EAPG 00356
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Sunshine Health Medicaid |
$0.37
|
|
|
Level I Radiation Therapy
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
EAPG 00343
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Sunshine Health Medicaid |
$0.37
|
|
|
Level I Radiation Treatment Preparation And Planning
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
EAPG 00476
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Sunshine Health Medicaid |
$0.24
|
|
|
Level I Shoulder And Upper Arm Procedures
|
Facility
|
OP
|
$10.08
|
|
|
Service Code
|
EAPG 00025
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$10.08 |
| Rate for Payer: Sunshine Health Medicaid |
$10.08
|
|
|
Level I Skin Excisions, Biopsies, And Repairs
|
Facility
|
OP
|
$0.87
|
|
|
Service Code
|
EAPG 00009
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Sunshine Health Medicaid |
$0.87
|
|
|
Level I Skin Incision And Drainage, Debridement, Destruction, Other Related Px
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
EAPG 00003
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Sunshine Health Medicaid |
$0.34
|
|
|
Level I Small And Large Intestine Surgical Procedures
|
Facility
|
OP
|
$4.27
|
|
|
Service Code
|
EAPG 00127
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Sunshine Health Medicaid |
$4.27
|
|
|
Level I Spine Procedures
|
Facility
|
OP
|
$10.57
|
|
|
Service Code
|
EAPG 00028
|
| Min. Negotiated Rate |
$10.57 |
| Max. Negotiated Rate |
$10.57 |
| Rate for Payer: Sunshine Health Medicaid |
$10.57
|
|
|
Level I Surgical Pathology Tests
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
EAPG 00305
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Sunshine Health Medicaid |
$0.07
|
|
