|
Toxicology Tests
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
EAPG 00404
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Sunshine Health Medicaid |
$0.02
|
|
|
Tracheostomy And Related Tracheal Procedures
|
Facility
|
OP
|
$4.97
|
|
|
Service Code
|
EAPG 00072
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Sunshine Health Medicaid |
$4.97
|
|
|
Transient Ischemia
|
Facility
|
OP
|
$0.58
|
|
|
Service Code
|
EAPG 00526
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Sunshine Health Medicaid |
$0.58
|
|
|
Transitional Care face to face w/in 14 days d/c
|
Professional
|
Both
|
$617.00
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
4899495
|
| Min. Negotiated Rate |
$107.58 |
| Max. Negotiated Rate |
$316.19 |
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$134.48
|
| Rate for Payer: Behavioral Services Network Commercial |
$147.93
|
| Rate for Payer: Behavioral Services Network Medicare |
$134.48
|
| Rate for Payer: Carelon Medicare |
$134.48
|
| Rate for Payer: Lucet Commercial |
$107.58
|
| Rate for Payer: Lucet Commercial |
$127.76
|
| Rate for Payer: Lucet Commercial |
$121.03
|
| Rate for Payer: Molina Complete Care Medicaid/Medicare |
$134.48
|
| Rate for Payer: Prime Health Services Workers Comp |
$316.19
|
|
|
Transitional Housing Services-Transitional Housing Services
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT H0043 HK
|
| Hospital Charge Code |
79H0043
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Carelon Medicaid |
$40.00
|
| Rate for Payer: Molina Complete Care Marketplace |
$105.00
|
|
|
Treatment Plan - new or reopened
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
CPT H0032
|
| Hospital Charge Code |
77H0032
|
| Min. Negotiated Rate |
$97.00 |
| Max. Negotiated Rate |
$97.86 |
| Rate for Payer: Carelon Medicaid |
$97.00
|
| Rate for Payer: Molina Complete Care Marketplace |
$97.86
|
|
|
Treatment Plan - new or reopened client
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
CPT T1007
|
| Hospital Charge Code |
91T1007
|
| Min. Negotiated Rate |
$97.00 |
| Max. Negotiated Rate |
$97.86 |
| Rate for Payer: Carelon Medicaid |
$97.00
|
| Rate for Payer: Molina Complete Care Marketplace |
$97.86
|
|
|
Treatment Plan Review
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
CPT H0032 TS
|
| Hospital Charge Code |
78H0032
|
| Min. Negotiated Rate |
$48.50 |
| Max. Negotiated Rate |
$97.86 |
| Rate for Payer: Carelon Medicaid |
$48.50
|
| Rate for Payer: Molina Complete Care Marketplace |
$97.86
|
|
|
Treatment Plan Review
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
CPT T1007 TS
|
| Hospital Charge Code |
92T1007
|
| Min. Negotiated Rate |
$48.50 |
| Max. Negotiated Rate |
$97.86 |
| Rate for Payer: Carelon Medicaid |
$48.50
|
| Rate for Payer: Molina Complete Care Marketplace |
$97.86
|
|
|
Ultrasound Guidance
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
EAPG 00472
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Sunshine Health Medicaid |
$0.22
|
|
|
Urinalysis
|
Facility
|
OP
|
$0.00
|
|
|
Service Code
|
EAPG 00410
|
| Rate for Payer: Sunshine Health Medicaid |
$0.00
|
|
|
Urinary Stones And Acquired Upper Urinary Tract Obstruction
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
EAPG 00724
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Sunshine Health Medicaid |
$0.32
|
|
|
Urinary Studies And Procedures
|
Facility
|
OP
|
$0.85
|
|
|
Service Code
|
EAPG 00161
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Sunshine Health Medicaid |
$0.85
|
|
|
Vaccine Administration
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
EAPG 00459
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Sunshine Health Medicaid |
$0.09
|
|
|
Vaginal Delivery Procedures
|
Facility
|
OP
|
$4.93
|
|
|
Service Code
|
EAPG 00195
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$4.93 |
| Rate for Payer: Sunshine Health Medicaid |
$4.93
|
|
|
Vascular Access By Needle Or Catheter
|
Facility
|
OP
|
$1.48
|
|
|
Service Code
|
EAPG 00423
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Sunshine Health Medicaid |
$1.48
|
|
|
Ventilation Assistance And Management
|
Facility
|
OP
|
$2.85
|
|
|
Service Code
|
EAPG 00067
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Sunshine Health Medicaid |
$2.85
|
|
|
Ventricular Assist Device Procedures
|
Facility
|
OP
|
$62.99
|
|
|
Service Code
|
EAPG 03060
|
| Min. Negotiated Rate |
$62.99 |
| Max. Negotiated Rate |
$62.99 |
| Rate for Payer: Sunshine Health Medicaid |
$62.99
|
|
|
Vertigo And Other Labyrinth Disorders
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
EAPG 00561
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Sunshine Health Medicaid |
$0.49
|
|
|
Viral Illness
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
EAPG 00808
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Sunshine Health Medicaid |
$0.62
|
|
|
Viral Meningitis
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
EAPG 00812
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Sunshine Health Medicaid |
$0.41
|
|
|
Vitals/Inj./Spec Col
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
CPT T1015 HE
|
| Hospital Charge Code |
94T1015
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Carelon Medicaid |
$10.00
|
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
|
|
Vitals/Inj./Spec Col
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
CPT H0048
|
| Hospital Charge Code |
80H0048
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$10.09 |
| Rate for Payer: Carelon Medicaid |
$10.00
|
| Rate for Payer: Molina Complete Care Marketplace |
$10.09
|
|
|
Vivitrol Service
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT J2315
|
| Hospital Charge Code |
89J2315
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$4.66 |
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$4.24
|
| Rate for Payer: Behavioral Services Network Commercial |
$4.66
|
| Rate for Payer: Behavioral Services Network Medicare |
$4.24
|
| Rate for Payer: Carelon Medicare |
$4.24
|
| Rate for Payer: Lucet Commercial |
$3.81
|
| Rate for Payer: Lucet Commercial |
$3.39
|
| Rate for Payer: Lucet Commercial |
$4.03
|
| Rate for Payer: Molina Complete Care Medicaid/Medicare |
$4.24
|
|
|
Vivitrol Service-SA
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
CPT 99408
|
| Hospital Charge Code |
4599408
|
| Min. Negotiated Rate |
$40.89 |
| Max. Negotiated Rate |
$52.82 |
| Rate for Payer: Humana Commercial |
$44.30
|
| Rate for Payer: Humana Commercial |
$40.89
|
| Rate for Payer: Humana Commercial |
$47.70
|
| Rate for Payer: Prime Health Services Workers Comp |
$52.82
|
|
