|
Level I Thoracic And Chest Procedures
|
Facility
|
OP
|
$4.85
|
|
|
Service Code
|
EAPG 00069
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Sunshine Health Medicaid |
$4.85
|
|
|
Level I Upper Gi Endoscopy
|
Facility
|
OP
|
$2.11
|
|
|
Service Code
|
EAPG 00134
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$2.11 |
| Rate for Payer: Sunshine Health Medicaid |
$2.11
|
|
|
Level I Urethral Procedures
|
Facility
|
OP
|
$6.32
|
|
|
Service Code
|
EAPG 00166
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$6.32 |
| Rate for Payer: Sunshine Health Medicaid |
$6.32
|
|
|
Level I Varicose Vein And Related Procedures
|
Facility
|
OP
|
$1.36
|
|
|
Service Code
|
EAPG 00090
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Sunshine Health Medicaid |
$1.36
|
|
|
Level I Vascular Radiological Procedures
|
Facility
|
OP
|
$2.58
|
|
|
Service Code
|
EAPG 00277
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Sunshine Health Medicaid |
$2.58
|
|
|
Level Iv Complex Laboratory, Molecular Pathology And Genetic Tests
|
Facility
|
OP
|
$1.11
|
|
|
Service Code
|
EAPG 02044
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Sunshine Health Medicaid |
$1.11
|
|
|
Level Iv Ear, Nose, Mouth And Throat Procedures
|
Facility
|
OP
|
$9.29
|
|
|
Service Code
|
EAPG 00255
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: Sunshine Health Medicaid |
$9.29
|
|
|
Limited Functional Assessment
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
CPT H0001 GT
|
| Hospital Charge Code |
65H0001
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Carelon Medicaid |
$15.00
|
|
|
Limited Functional Assessment
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
CPT H0031 GT
|
| Hospital Charge Code |
75H0031
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Carelon Medicaid |
$15.00
|
|
|
Limited Functional Assessment
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
CPT H0001 GT
|
| Hospital Charge Code |
66H0001
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Carelon Medicaid |
$15.00
|
|
|
Limited Functional Assessment
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
CPT H0031
|
| Hospital Charge Code |
76H0031
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Carelon Medicaid |
$15.00
|
|
|
Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
EAPG 00804
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Sunshine Health Medicaid |
$0.35
|
|
|
Lymphoma, Myeloma And Non-Acute Leukemia
|
Facility
|
OP
|
$0.39
|
|
|
Service Code
|
EAPG 00801
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Sunshine Health Medicaid |
$0.39
|
|
|
Magnetic Resonance Angiography
|
Facility
|
OP
|
$0.97
|
|
|
Service Code
|
EAPG 00282
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Sunshine Health Medicaid |
$0.97
|
|
|
Magnetic Resonance Imaging With Contrast
|
Facility
|
OP
|
$0.83
|
|
|
Service Code
|
EAPG 00295
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Sunshine Health Medicaid |
$0.83
|
|
|
Magnetic Resonance Imaging Without Contrast
|
Facility
|
OP
|
$0.50
|
|
|
Service Code
|
EAPG 00293
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Sunshine Health Medicaid |
$0.50
|
|
|
Magnetocephalography
|
Facility
|
OP
|
$8.66
|
|
|
Service Code
|
EAPG 00297
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Sunshine Health Medicaid |
$8.66
|
|
|
Major Chest And Respiratory Trauma
|
Facility
|
OP
|
$0.85
|
|
|
Service Code
|
EAPG 00580
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Sunshine Health Medicaid |
$0.85
|
|
|
Major Craniotomy And Craniectomy Surgical Procedures
|
Facility
|
OP
|
$8.59
|
|
|
Service Code
|
EAPG 00264
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$8.59 |
| Rate for Payer: Sunshine Health Medicaid |
$8.59
|
|
|
Major Depressive Diagnoses And Other Or Unspecified Psychoses
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
EAPG 00821
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Sunshine Health Medicaid |
$0.30
|
|
|
Major Open Abdominal And Thoracic Vascular Procedures
|
Facility
|
OP
|
$17.59
|
|
|
Service Code
|
EAPG 00106
|
| Min. Negotiated Rate |
$17.59 |
| Max. Negotiated Rate |
$17.59 |
| Rate for Payer: Sunshine Health Medicaid |
$17.59
|
|
|
Major Open Cardiac And Cardiac Valve Procedures
|
Facility
|
OP
|
$24.25
|
|
|
Service Code
|
EAPG 00105
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$24.25 |
| Rate for Payer: Sunshine Health Medicaid |
$24.25
|
|
|
Major Open Coronary Artery Procedures Including Cabg
|
Facility
|
OP
|
$33.10
|
|
|
Service Code
|
EAPG 00104
|
| Min. Negotiated Rate |
$33.10 |
| Max. Negotiated Rate |
$33.10 |
| Rate for Payer: Sunshine Health Medicaid |
$33.10
|
|
|
Major Skin Diagnoses
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
EAPG 00671
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Sunshine Health Medicaid |
$0.25
|
|
|
Male Reproductive System Infections
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
EAPG 00744
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Sunshine Health Medicaid |
$0.31
|
|
