|
Artificial Fertilization
|
Facility
|
OP
|
$1.05
|
|
|
Service Code
|
EAPG 00190
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Sunshine Health Medicaid |
$1.05
|
|
|
Asthma
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
EAPG 00575
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Sunshine Health Medicaid |
$0.44
|
|
|
Atrial Fibrillation
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
EAPG 00602
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Sunshine Health Medicaid |
$0.32
|
|
|
Audiometry
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
EAPG 00257
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Sunshine Health Medicaid |
$0.16
|
|
|
Autopsy And Post-Mortem Examination Services
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
EAPG 00900
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Sunshine Health Medicaid |
$0.32
|
|
|
Bacterial And Tuberculous Infections Of Nervous System
|
Facility
|
OP
|
$0.45
|
|
|
Service Code
|
EAPG 00518
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Sunshine Health Medicaid |
$0.45
|
|
|
Basic Chemistry Tests
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
EAPG 00402
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Sunshine Health Medicaid |
$0.01
|
|
|
Basic Eye Exam
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
CPT 92002
|
| Hospital Charge Code |
2892002
|
| Min. Negotiated Rate |
$34.23 |
| Max. Negotiated Rate |
$127.06 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$67.29
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$42.79
|
| Rate for Payer: Behavioral Services Network Commercial |
$47.07
|
| Rate for Payer: Behavioral Services Network Medicare |
$42.79
|
| Rate for Payer: Carelon Medicare |
$42.79
|
| Rate for Payer: Lucet Commercial |
$38.51
|
| Rate for Payer: Lucet Commercial |
$40.65
|
| Rate for Payer: Lucet Commercial |
$34.23
|
| Rate for Payer: Magellan Medicaid |
$64.09
|
| Rate for Payer: Molina Complete Care Medicaid/Medicare |
$42.79
|
| Rate for Payer: Prime Health Services Workers Comp |
$127.06
|
|
|
Behavioral And Substance Abuse Partial Hospitalization Program
|
Facility
|
OP
|
$1.24
|
|
|
Service Code
|
EAPG 00312
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Sunshine Health Medicaid |
$1.24
|
|
|
Behavioral Health Assessment
|
Facility
|
OP
|
$0.51
|
|
|
Service Code
|
EAPG 00323
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Sunshine Health Medicaid |
$0.51
|
|
|
Behavioral Health - Case Management And Treatment Plan Development
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
EAPG 00320
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Sunshine Health Medicaid |
$0.17
|
|
|
Behavioral Health Residential Treatment
|
Facility
|
OP
|
$1.10
|
|
|
Service Code
|
EAPG 00333
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Sunshine Health Medicaid |
$1.10
|
|
|
Biofeedback And Other Training
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
EAPG 00427
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Sunshine Health Medicaid |
$0.25
|
|
|
Bio-Psychosocial
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
CPT H0031 HN
|
| Hospital Charge Code |
69H0031
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Carelon Medicaid |
$48.00
|
|
|
Bio-Psychosocial
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
CPT H0001 GT
|
| Hospital Charge Code |
60H0001
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Carelon Medicaid |
$15.00
|
|
|
Bio-Psychosocial
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
CPT H0031 GT
|
| Hospital Charge Code |
68H0031
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Carelon Medicaid |
$15.00
|
|
|
Bipolar Disorders
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
EAPG 00823
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Sunshine Health Medicaid |
$0.35
|
|
|
Blood Processing, Storage And Related Services
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
EAPG 00499
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Sunshine Health Medicaid |
$0.18
|
|
|
Bone Conduction Hearing Device Implantation
|
Facility
|
OP
|
$18.15
|
|
|
Service Code
|
EAPG 03011
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Sunshine Health Medicaid |
$18.15
|
|
|
Bone Density And Related Procedures
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
EAPG 00291
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Sunshine Health Medicaid |
$0.15
|
|
|
Bone Marrow Biopsies
|
Facility
|
OP
|
$4.05
|
|
|
Service Code
|
EAPG 00124
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Sunshine Health Medicaid |
$4.05
|
|
|
Bone Or Joint Manipulation Under Anesthesia
|
Facility
|
OP
|
$2.16
|
|
|
Service Code
|
EAPG 00044
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Sunshine Health Medicaid |
$2.16
|
|
|
Breast Biopsies, Excisions, And Other Related Procedures
|
Facility
|
OP
|
$2.79
|
|
|
Service Code
|
EAPG 00020
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Sunshine Health Medicaid |
$2.79
|
|
|
Brief Behavioral Status Exam
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
CPT H2010 HO
|
| Hospital Charge Code |
83H2010
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$14.79 |
| Rate for Payer: Carelon Medicaid |
$14.66
|
| Rate for Payer: Molina Complete Care Marketplace |
$14.79
|
|
|
Bronchiolitis And Rsv Pneumonia
|
Facility
|
OP
|
$0.81
|
|
|
Service Code
|
EAPG 00572
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Sunshine Health Medicaid |
$0.81
|
|
