|
Obesity counseling, 15 mins (G0447)
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
CPT G0447
|
| Hospital Charge Code |
73G0447
|
| Min. Negotiated Rate |
$15.67 |
| Max. Negotiated Rate |
$41.22 |
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$22.02
|
| Rate for Payer: Behavioral Services Network Medicare |
$22.02
|
| Rate for Payer: Carelon Medicare |
$22.02
|
| Rate for Payer: Lucet Commercial |
$16.52
|
| Rate for Payer: Lucet Commercial |
$18.72
|
| Rate for Payer: Lucet Commercial |
$19.82
|
| Rate for Payer: Molina Complete Care Medicare |
$22.02
|
| Rate for Payer: Prime Health Services Workers Comp |
$41.22
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$22.02
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$15.67
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$16.79
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$17.91
|
|
|
PC Office Visit - Est. Pt. Detailed (Moderate Complexity 99214)
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
6499214
|
| Min. Negotiated Rate |
$42.74 |
| Max. Negotiated Rate |
$197.42 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$56.10
|
| Rate for Payer: Humana Commercial |
$146.86
|
| Rate for Payer: Humana Commercial |
$136.37
|
| Rate for Payer: Humana Medicare |
$136.37
|
| Rate for Payer: Humana Medicare |
$146.86
|
| Rate for Payer: Magellan Medicaid |
$53.43
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$53.43
|
| Rate for Payer: Prime Health Services Workers Comp |
$197.42
|
| Rate for Payer: Sunshine Health FHK |
$53.43
|
| Rate for Payer: Sunshine Health Medicaid |
$42.74
|
| Rate for Payer: Sunshine Health Medicaid |
$53.43
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$72.54
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$67.70
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$77.38
|
|
|
PC Office Visit - Est. Pt. Focused (Low Complexity 99213)
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
6199213
|
| Min. Negotiated Rate |
$27.43 |
| Max. Negotiated Rate |
$139.81 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$36.00
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$64.61
|
| Rate for Payer: Behavioral Services Network Medicare |
$64.61
|
| Rate for Payer: Carelon Commercial/Medicare |
$51.12
|
| Rate for Payer: Carelon Medicare |
$64.61
|
| Rate for Payer: Humana Commercial |
$100.06
|
| Rate for Payer: Humana Commercial |
$92.92
|
| Rate for Payer: Humana Medicare |
$92.92
|
| Rate for Payer: Humana Medicare |
$100.06
|
| Rate for Payer: Lucet Commercial |
$58.15
|
| Rate for Payer: Lucet Commercial |
$48.46
|
| Rate for Payer: Lucet Commercial |
$54.92
|
| Rate for Payer: Magellan Medicaid |
$34.29
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$34.29
|
| Rate for Payer: Molina Complete Care Medicare |
$64.61
|
| Rate for Payer: Prime Health Services Workers Comp |
$139.81
|
| Rate for Payer: Sunshine Health FHK |
$34.29
|
| Rate for Payer: Sunshine Health Medicaid |
$34.29
|
| Rate for Payer: Sunshine Health Medicaid |
$27.43
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$64.61
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$49.26
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$52.54
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$45.98
|
|
|
PC Office Visit - Est. Pt. (High Complexity 99215)
|
Professional
|
Both
|
$545.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
6799215
|
| Min. Negotiated Rate |
$68.36 |
| Max. Negotiated Rate |
$278.85 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$89.72
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$141.34
|
| Rate for Payer: Behavioral Services Network Medicare |
$141.34
|
| Rate for Payer: Carelon Medicare |
$141.34
|
| Rate for Payer: Humana Commercial |
$196.76
|
| Rate for Payer: Humana Commercial |
$182.70
|
| Rate for Payer: Humana Medicare |
$182.70
|
| Rate for Payer: Humana Medicare |
$196.76
|
| Rate for Payer: Lucet Commercial |
$127.21
|
| Rate for Payer: Lucet Commercial |
$106.00
|
| Rate for Payer: Lucet Commercial |
$120.14
|
| Rate for Payer: Magellan Medicaid |
$85.45
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$85.45
|
| Rate for Payer: Molina Complete Care Medicare |
$141.34
|
| Rate for Payer: Prime Health Services Workers Comp |
$278.85
|
| Rate for Payer: Sunshine Health FHK |
$85.45
|
| Rate for Payer: Sunshine Health Medicaid |
$85.45
|
| Rate for Payer: Sunshine Health Medicaid |
$68.36
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$141.34
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$114.94
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$100.58
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$107.76
|
|
|
PC Office Visit - Est. Pt. (Minimal 99211)
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
4999211
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$34.95 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$18.48
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$8.53
|
| Rate for Payer: Behavioral Services Network Medicare |
$8.53
|
| Rate for Payer: Carelon Medicare |
$8.53
|
| Rate for Payer: Humana Commercial |
$25.69
|
| Rate for Payer: Humana Commercial |
$27.66
|
| Rate for Payer: Humana Medicare |
$27.66
|
| Rate for Payer: Humana Medicare |
$25.69
|
| Rate for Payer: Lucet Commercial |
$7.68
|
| Rate for Payer: Lucet Commercial |
$6.40
|
| Rate for Payer: Lucet Commercial |
$7.25
|
| Rate for Payer: Magellan Medicaid |
$17.60
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$17.60
|
| Rate for Payer: Molina Complete Care Medicare |
$8.53
|
| Rate for Payer: Prime Health Services Workers Comp |
$34.95
|
| Rate for Payer: Sunshine Health FHK |
$17.60
|
| Rate for Payer: Sunshine Health Medicaid |
$17.60
|
| Rate for Payer: Sunshine Health Medicaid |
$14.08
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$8.53
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$6.50
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$6.07
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$6.94
|
|
|
PC Office Visit - Est. Pt. (Straightforward Complexity 99212)
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
5799212
|
| Min. Negotiated Rate |
$22.51 |
| Max. Negotiated Rate |
$86.66 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$29.55
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$34.73
|
| Rate for Payer: Behavioral Services Network Medicare |
$34.73
|
| Rate for Payer: Carelon Medicare |
$34.73
|
| Rate for Payer: Humana Commercial |
$60.09
|
| Rate for Payer: Humana Commercial |
$55.80
|
| Rate for Payer: Humana Medicare |
$55.80
|
| Rate for Payer: Humana Medicare |
$60.09
|
| Rate for Payer: Lucet Commercial |
$29.52
|
| Rate for Payer: Lucet Commercial |
$26.05
|
| Rate for Payer: Lucet Commercial |
$31.26
|
| Rate for Payer: Magellan Medicaid |
$28.14
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$28.14
|
| Rate for Payer: Molina Complete Care Medicare |
$34.73
|
| Rate for Payer: Prime Health Services Workers Comp |
$86.66
|
| Rate for Payer: Sunshine Health FHK |
$28.14
|
| Rate for Payer: Sunshine Health Medicaid |
$22.51
|
| Rate for Payer: Sunshine Health Medicaid |
$28.14
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$34.73
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$26.48
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$24.71
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$28.24
|
|
|
PC Office Visit - New Pt. Detailed (Low Complexity 99203)
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
3599203
|
| Min. Negotiated Rate |
$57.64 |
| Max. Negotiated Rate |
$172.60 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$88.45
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$81.01
|
| Rate for Payer: Behavioral Services Network Medicare |
$81.01
|
| Rate for Payer: Carelon Medicare |
$81.01
|
| Rate for Payer: Humana Commercial |
$149.63
|
| Rate for Payer: Humana Commercial |
$138.94
|
| Rate for Payer: Humana Medicare |
$138.94
|
| Rate for Payer: Humana Medicare |
$149.63
|
| Rate for Payer: Lucet Commercial |
$72.91
|
| Rate for Payer: Lucet Commercial |
$68.86
|
| Rate for Payer: Lucet Commercial |
$60.76
|
| Rate for Payer: Magellan Medicaid |
$84.24
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$84.24
|
| Rate for Payer: Molina Complete Care Medicare |
$81.01
|
| Rate for Payer: Prime Health Services Workers Comp |
$172.60
|
| Rate for Payer: Sunshine Health FHK |
$84.24
|
| Rate for Payer: Sunshine Health Medicaid |
$67.39
|
| Rate for Payer: Sunshine Health Medicaid |
$84.24
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$81.01
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$57.64
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$61.76
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$65.88
|
|
|
PC Office Visit - New Pt. (High Complexity 99205)
|
Professional
|
Both
|
$671.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
4199205
|
| Min. Negotiated Rate |
$127.22 |
| Max. Negotiated Rate |
$342.51 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$174.78
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$178.78
|
| Rate for Payer: Behavioral Services Network Medicare |
$178.78
|
| Rate for Payer: Carelon Medicare |
$178.78
|
| Rate for Payer: Humana Commercial |
$262.57
|
| Rate for Payer: Humana Commercial |
$282.77
|
| Rate for Payer: Humana Medicare |
$282.77
|
| Rate for Payer: Humana Medicare |
$262.57
|
| Rate for Payer: Lucet Commercial |
$151.96
|
| Rate for Payer: Lucet Commercial |
$160.90
|
| Rate for Payer: Lucet Commercial |
$134.08
|
| Rate for Payer: Magellan Medicaid |
$166.46
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$166.46
|
| Rate for Payer: Molina Complete Care Medicare |
$178.78
|
| Rate for Payer: Prime Health Services Workers Comp |
$342.51
|
| Rate for Payer: Sunshine Health FHK |
$166.46
|
| Rate for Payer: Sunshine Health Medicaid |
$166.46
|
| Rate for Payer: Sunshine Health Medicaid |
$133.17
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$178.78
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$127.22
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$136.30
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$145.39
|
|
|
PC Office Visit - New Pt. (Low Complexity 99202)
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
3299202
|
| Min. Negotiated Rate |
$33.17 |
| Max. Negotiated Rate |
$110.83 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$57.30
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$46.61
|
| Rate for Payer: Behavioral Services Network Medicare |
$46.61
|
| Rate for Payer: Carelon Medicare |
$46.61
|
| Rate for Payer: Humana Commercial |
$94.95
|
| Rate for Payer: Humana Commercial |
$102.26
|
| Rate for Payer: Humana Medicare |
$94.95
|
| Rate for Payer: Humana Medicare |
$102.26
|
| Rate for Payer: Lucet Commercial |
$39.62
|
| Rate for Payer: Lucet Commercial |
$34.96
|
| Rate for Payer: Lucet Commercial |
$41.95
|
| Rate for Payer: Magellan Medicaid |
$54.57
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$54.57
|
| Rate for Payer: Molina Complete Care Medicare |
$46.61
|
| Rate for Payer: Prime Health Services Workers Comp |
$110.83
|
| Rate for Payer: Sunshine Health FHK |
$54.57
|
| Rate for Payer: Sunshine Health Medicaid |
$54.57
|
| Rate for Payer: Sunshine Health Medicaid |
$43.66
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$46.61
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$33.17
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$35.54
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$37.90
|
|
|
PC Office Visit - New Pt. (Moderate Complexity 99204)
|
Professional
|
Both
|
$507.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
3899204
|
| Min. Negotiated Rate |
$93.53 |
| Max. Negotiated Rate |
$259.28 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$132.54
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$131.44
|
| Rate for Payer: Behavioral Services Network Medicare |
$131.44
|
| Rate for Payer: Carelon Medicare |
$131.44
|
| Rate for Payer: Humana Commercial |
$228.62
|
| Rate for Payer: Humana Commercial |
$212.28
|
| Rate for Payer: Humana Medicare |
$212.28
|
| Rate for Payer: Humana Medicare |
$228.62
|
| Rate for Payer: Lucet Commercial |
$111.72
|
| Rate for Payer: Lucet Commercial |
$98.58
|
| Rate for Payer: Lucet Commercial |
$118.30
|
| Rate for Payer: Magellan Medicaid |
$126.23
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$126.23
|
| Rate for Payer: Molina Complete Care Medicare |
$131.44
|
| Rate for Payer: Prime Health Services Workers Comp |
$259.28
|
| Rate for Payer: Sunshine Health FHK |
$126.23
|
| Rate for Payer: Sunshine Health Medicaid |
$100.98
|
| Rate for Payer: Sunshine Health Medicaid |
$126.23
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$131.44
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$106.90
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$93.53
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$100.22
|
|
|
Psych - Diagnostic Eval MD 90792
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
1390792
|
| Min. Negotiated Rate |
$107.47 |
| Max. Negotiated Rate |
$301.21 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$141.06
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$167.47
|
| Rate for Payer: Behavioral Services Network Medicare |
$167.47
|
| Rate for Payer: Carelon Medicare |
$167.47
|
| Rate for Payer: Humana Commercial |
$160.03
|
| Rate for Payer: Humana Commercial |
$147.73
|
| Rate for Payer: Humana Commercial |
$172.35
|
| Rate for Payer: Humana Medicare |
$160.03
|
| Rate for Payer: Humana Medicare |
$172.35
|
| Rate for Payer: Humana Medicare |
$147.73
|
| Rate for Payer: Lucet Commercial |
$142.35
|
| Rate for Payer: Lucet Commercial |
$150.72
|
| Rate for Payer: Lucet Commercial |
$125.60
|
| Rate for Payer: Magellan Medicaid |
$134.34
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$134.34
|
| Rate for Payer: Molina Complete Care Medicare |
$167.47
|
| Rate for Payer: Prime Health Services Workers Comp |
$301.21
|
| Rate for Payer: Sunshine Health FHK |
$134.34
|
| Rate for Payer: Sunshine Health Medicaid |
$107.47
|
| Rate for Payer: Sunshine Health Medicaid |
$134.34
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$167.47
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$119.17
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$136.19
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$127.68
|
|
|
Psychiatric Diag Eval-90791
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
690791
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$266.62 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$127.47
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$145.62
|
| Rate for Payer: Behavioral Services Network Medicare |
$145.62
|
| Rate for Payer: Carelon Commercial/Medicare |
$60.00
|
| Rate for Payer: Carelon Commercial/Medicare |
$55.00
|
| Rate for Payer: Carelon Medicare |
$145.62
|
| Rate for Payer: Humana Commercial |
$207.37
|
| Rate for Payer: Humana Commercial |
$177.74
|
| Rate for Payer: Humana Commercial |
$192.56
|
| Rate for Payer: Humana Medicare |
$192.56
|
| Rate for Payer: Humana Medicare |
$207.37
|
| Rate for Payer: Humana Medicare |
$177.74
|
| Rate for Payer: Lucet Commercial |
$123.78
|
| Rate for Payer: Lucet Commercial |
$131.06
|
| Rate for Payer: Lucet Commercial |
$109.22
|
| Rate for Payer: Magellan Medicaid |
$121.40
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$121.40
|
| Rate for Payer: Molina Complete Care Medicare |
$145.62
|
| Rate for Payer: Prime Health Services Workers Comp |
$266.62
|
| Rate for Payer: Sunshine Health FHK |
$121.40
|
| Rate for Payer: Sunshine Health Medicaid |
$121.40
|
| Rate for Payer: Sunshine Health Medicaid |
$97.12
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$145.62
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$111.03
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$103.63
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$118.43
|
|
|
Psychiatric Diag Eval-90792
|
Professional
|
Both
|
$157.71
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
1490792
|
| Min. Negotiated Rate |
$107.47 |
| Max. Negotiated Rate |
$301.21 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$141.06
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$167.47
|
| Rate for Payer: Behavioral Services Network Medicare |
$167.47
|
| Rate for Payer: Carelon Medicare |
$167.47
|
| Rate for Payer: Humana Commercial |
$172.35
|
| Rate for Payer: Humana Commercial |
$160.03
|
| Rate for Payer: Humana Commercial |
$147.73
|
| Rate for Payer: Humana Medicare |
$147.73
|
| Rate for Payer: Humana Medicare |
$160.03
|
| Rate for Payer: Humana Medicare |
$172.35
|
| Rate for Payer: Lucet Commercial |
$150.72
|
| Rate for Payer: Lucet Commercial |
$142.35
|
| Rate for Payer: Lucet Commercial |
$125.60
|
| Rate for Payer: Magellan Medicaid |
$134.34
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$134.34
|
| Rate for Payer: Molina Complete Care Medicare |
$167.47
|
| Rate for Payer: Prime Health Services Workers Comp |
$301.21
|
| Rate for Payer: Sunshine Health FHK |
$134.34
|
| Rate for Payer: Sunshine Health Medicaid |
$107.47
|
| Rate for Payer: Sunshine Health Medicaid |
$134.34
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$167.47
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$136.19
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$127.68
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$119.17
|
|
|
Psychiatric Diagnosis Examination MD
|
Professional
|
Both
|
$196.33
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
1590792
|
| Min. Negotiated Rate |
$107.47 |
| Max. Negotiated Rate |
$301.21 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$141.06
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$167.47
|
| Rate for Payer: Behavioral Services Network Medicare |
$167.47
|
| Rate for Payer: Carelon Medicare |
$167.47
|
| Rate for Payer: Humana Commercial |
$160.03
|
| Rate for Payer: Humana Commercial |
$147.73
|
| Rate for Payer: Humana Commercial |
$172.35
|
| Rate for Payer: Humana Medicare |
$172.35
|
| Rate for Payer: Humana Medicare |
$160.03
|
| Rate for Payer: Humana Medicare |
$147.73
|
| Rate for Payer: Lucet Commercial |
$125.60
|
| Rate for Payer: Lucet Commercial |
$142.35
|
| Rate for Payer: Lucet Commercial |
$150.72
|
| Rate for Payer: Magellan Medicaid |
$134.34
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$134.34
|
| Rate for Payer: Molina Complete Care Medicare |
$167.47
|
| Rate for Payer: Prime Health Services Workers Comp |
$301.21
|
| Rate for Payer: Sunshine Health FHK |
$134.34
|
| Rate for Payer: Sunshine Health Medicaid |
$107.47
|
| Rate for Payer: Sunshine Health Medicaid |
$134.34
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$167.47
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$136.19
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$119.17
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$127.68
|
|
|
Psychiatric Evaluation - 90791
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
790791
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$266.62 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$127.47
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$145.62
|
| Rate for Payer: Behavioral Services Network Medicare |
$145.62
|
| Rate for Payer: Carelon Commercial/Medicare |
$55.00
|
| Rate for Payer: Carelon Commercial/Medicare |
$60.00
|
| Rate for Payer: Carelon Medicare |
$145.62
|
| Rate for Payer: Humana Commercial |
$177.74
|
| Rate for Payer: Humana Commercial |
$192.56
|
| Rate for Payer: Humana Commercial |
$207.37
|
| Rate for Payer: Humana Medicare |
$192.56
|
| Rate for Payer: Humana Medicare |
$177.74
|
| Rate for Payer: Humana Medicare |
$207.37
|
| Rate for Payer: Lucet Commercial |
$109.22
|
| Rate for Payer: Lucet Commercial |
$131.06
|
| Rate for Payer: Lucet Commercial |
$123.78
|
| Rate for Payer: Magellan Medicaid |
$121.40
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$121.40
|
| Rate for Payer: Molina Complete Care Medicare |
$145.62
|
| Rate for Payer: Prime Health Services Workers Comp |
$266.62
|
| Rate for Payer: Sunshine Health FHK |
$121.40
|
| Rate for Payer: Sunshine Health Medicaid |
$121.40
|
| Rate for Payer: Sunshine Health Medicaid |
$97.12
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$145.62
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$103.63
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$111.03
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$118.43
|
|
|
Psychiatric Evaluation 90791
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
890791
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$266.62 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$127.47
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$145.62
|
| Rate for Payer: Behavioral Services Network Medicare |
$145.62
|
| Rate for Payer: Carelon Commercial/Medicare |
$60.00
|
| Rate for Payer: Carelon Commercial/Medicare |
$55.00
|
| Rate for Payer: Carelon Medicare |
$145.62
|
| Rate for Payer: Humana Commercial |
$207.37
|
| Rate for Payer: Humana Commercial |
$192.56
|
| Rate for Payer: Humana Commercial |
$177.74
|
| Rate for Payer: Humana Medicare |
$207.37
|
| Rate for Payer: Humana Medicare |
$192.56
|
| Rate for Payer: Humana Medicare |
$177.74
|
| Rate for Payer: Lucet Commercial |
$109.22
|
| Rate for Payer: Lucet Commercial |
$123.78
|
| Rate for Payer: Lucet Commercial |
$131.06
|
| Rate for Payer: Magellan Medicaid |
$121.40
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$121.40
|
| Rate for Payer: Molina Complete Care Medicare |
$145.62
|
| Rate for Payer: Prime Health Services Workers Comp |
$266.62
|
| Rate for Payer: Sunshine Health FHK |
$121.40
|
| Rate for Payer: Sunshine Health Medicaid |
$121.40
|
| Rate for Payer: Sunshine Health Medicaid |
$97.12
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$145.62
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$111.03
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$103.63
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$118.43
|
|
|
Psychiatric Evaluation 90792
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
1690792
|
| Min. Negotiated Rate |
$107.47 |
| Max. Negotiated Rate |
$301.21 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$141.06
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$167.47
|
| Rate for Payer: Behavioral Services Network Medicare |
$167.47
|
| Rate for Payer: Carelon Medicare |
$167.47
|
| Rate for Payer: Humana Commercial |
$172.35
|
| Rate for Payer: Humana Commercial |
$160.03
|
| Rate for Payer: Humana Commercial |
$147.73
|
| Rate for Payer: Humana Medicare |
$172.35
|
| Rate for Payer: Humana Medicare |
$147.73
|
| Rate for Payer: Humana Medicare |
$160.03
|
| Rate for Payer: Lucet Commercial |
$150.72
|
| Rate for Payer: Lucet Commercial |
$125.60
|
| Rate for Payer: Lucet Commercial |
$142.35
|
| Rate for Payer: Magellan Medicaid |
$134.34
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$134.34
|
| Rate for Payer: Molina Complete Care Medicare |
$167.47
|
| Rate for Payer: Prime Health Services Workers Comp |
$301.21
|
| Rate for Payer: Sunshine Health FHK |
$134.34
|
| Rate for Payer: Sunshine Health Medicaid |
$107.47
|
| Rate for Payer: Sunshine Health Medicaid |
$134.34
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$167.47
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$127.68
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$119.17
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$136.19
|
|
|
Psychiatric Evaluation by Non-Physician
|
Professional
|
Both
|
$179.02
|
|
|
Service Code
|
CPT H2000
|
| Hospital Charge Code |
108H2000
|
| Min. Negotiated Rate |
$24.82 |
| Max. Negotiated Rate |
$32.58 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$32.58
|
| Rate for Payer: Carelon Medicaid |
$26.00
|
| Rate for Payer: Magellan Medicaid |
$31.03
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$31.03
|
| Rate for Payer: Sunshine Health FHK |
$31.03
|
| Rate for Payer: Sunshine Health Medicaid |
$31.03
|
| Rate for Payer: Sunshine Health Medicaid |
$24.82
|
|
|
Psychiatric Evaluation by Non-Physician
|
Professional
|
Both
|
$187.97
|
|
|
Service Code
|
CPT H2000 HO
|
| Hospital Charge Code |
109H2000
|
| Min. Negotiated Rate |
$143.22 |
| Max. Negotiated Rate |
$187.97 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$187.97
|
| Rate for Payer: Carelon Medicaid |
$150.00
|
| Rate for Payer: Magellan Medicaid |
$179.02
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$179.02
|
| Rate for Payer: Sunshine Health FHK |
$179.02
|
| Rate for Payer: Sunshine Health Medicaid |
$143.22
|
| Rate for Payer: Sunshine Health Medicaid |
$179.02
|
|
|
Psychiatric Evaluation by Non-Physician
|
Professional
|
Both
|
$173.91
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
990791
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$266.62 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$127.47
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$145.62
|
| Rate for Payer: Behavioral Services Network Medicare |
$145.62
|
| Rate for Payer: Carelon Commercial/Medicare |
$60.00
|
| Rate for Payer: Carelon Commercial/Medicare |
$55.00
|
| Rate for Payer: Carelon Medicare |
$145.62
|
| Rate for Payer: Humana Commercial |
$207.37
|
| Rate for Payer: Humana Commercial |
$177.74
|
| Rate for Payer: Humana Commercial |
$192.56
|
| Rate for Payer: Humana Medicare |
$177.74
|
| Rate for Payer: Humana Medicare |
$207.37
|
| Rate for Payer: Humana Medicare |
$192.56
|
| Rate for Payer: Lucet Commercial |
$123.78
|
| Rate for Payer: Lucet Commercial |
$131.06
|
| Rate for Payer: Lucet Commercial |
$109.22
|
| Rate for Payer: Magellan Medicaid |
$121.40
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$121.40
|
| Rate for Payer: Molina Complete Care Medicare |
$145.62
|
| Rate for Payer: Prime Health Services Workers Comp |
$266.62
|
| Rate for Payer: Sunshine Health FHK |
$121.40
|
| Rate for Payer: Sunshine Health Medicaid |
$121.40
|
| Rate for Payer: Sunshine Health Medicaid |
$97.12
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$145.62
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$111.03
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$103.63
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$118.43
|
|
|
Psychiatric Evaluation by Non-Physician H2000
|
Professional
|
Both
|
$179.02
|
|
|
Service Code
|
CPT H2000
|
| Hospital Charge Code |
110H2000
|
| Min. Negotiated Rate |
$24.82 |
| Max. Negotiated Rate |
$32.58 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$32.58
|
| Rate for Payer: Carelon Medicaid |
$26.00
|
| Rate for Payer: Magellan Medicaid |
$31.03
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$31.03
|
| Rate for Payer: Sunshine Health FHK |
$31.03
|
| Rate for Payer: Sunshine Health Medicaid |
$24.82
|
| Rate for Payer: Sunshine Health Medicaid |
$31.03
|
|
|
Psychiatric Evaluation by Non-Physician H2000HO
|
Professional
|
Both
|
$187.97
|
|
|
Service Code
|
CPT H2000 HO
|
| Hospital Charge Code |
111H2000
|
| Min. Negotiated Rate |
$143.22 |
| Max. Negotiated Rate |
$187.97 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$187.97
|
| Rate for Payer: Carelon Medicaid |
$150.00
|
| Rate for Payer: Magellan Medicaid |
$179.02
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$179.02
|
| Rate for Payer: Sunshine Health FHK |
$179.02
|
| Rate for Payer: Sunshine Health Medicaid |
$143.22
|
| Rate for Payer: Sunshine Health Medicaid |
$179.02
|
|
|
Psychiatric Evaluation by Physician
|
Professional
|
Both
|
$263.16
|
|
|
Service Code
|
CPT H2000 HP
|
| Hospital Charge Code |
113H2000
|
| Min. Negotiated Rate |
$200.50 |
| Max. Negotiated Rate |
$263.16 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$263.16
|
| Rate for Payer: Carelon Medicaid |
$210.00
|
| Rate for Payer: Magellan Medicaid |
$250.63
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$250.63
|
| Rate for Payer: Molina Complete Care Marketplace |
$263.16
|
| Rate for Payer: Sunshine Health FHK |
$250.63
|
| Rate for Payer: Sunshine Health Medicaid |
$200.50
|
| Rate for Payer: Sunshine Health Medicaid |
$250.63
|
|
|
Psychiatric Evaluation by Physician
|
Professional
|
Both
|
$250.63
|
|
|
Service Code
|
CPT H2000
|
| Hospital Charge Code |
112H2000
|
| Min. Negotiated Rate |
$24.82 |
| Max. Negotiated Rate |
$32.58 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$32.58
|
| Rate for Payer: Carelon Medicaid |
$26.00
|
| Rate for Payer: Magellan Medicaid |
$31.03
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$31.03
|
| Rate for Payer: Sunshine Health FHK |
$31.03
|
| Rate for Payer: Sunshine Health Medicaid |
$31.03
|
| Rate for Payer: Sunshine Health Medicaid |
$24.82
|
|
|
Psychiatric Evaluation by Physician 90791
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
1090791
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$266.62 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$127.47
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$145.62
|
| Rate for Payer: Behavioral Services Network Medicare |
$145.62
|
| Rate for Payer: Carelon Commercial/Medicare |
$60.00
|
| Rate for Payer: Carelon Commercial/Medicare |
$55.00
|
| Rate for Payer: Carelon Medicare |
$145.62
|
| Rate for Payer: Humana Commercial |
$192.56
|
| Rate for Payer: Humana Commercial |
$207.37
|
| Rate for Payer: Humana Commercial |
$177.74
|
| Rate for Payer: Humana Medicare |
$177.74
|
| Rate for Payer: Humana Medicare |
$192.56
|
| Rate for Payer: Humana Medicare |
$207.37
|
| Rate for Payer: Lucet Commercial |
$123.78
|
| Rate for Payer: Lucet Commercial |
$131.06
|
| Rate for Payer: Lucet Commercial |
$109.22
|
| Rate for Payer: Magellan Medicaid |
$121.40
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$121.40
|
| Rate for Payer: Molina Complete Care Medicare |
$145.62
|
| Rate for Payer: Prime Health Services Workers Comp |
$266.62
|
| Rate for Payer: Sunshine Health FHK |
$121.40
|
| Rate for Payer: Sunshine Health Medicaid |
$121.40
|
| Rate for Payer: Sunshine Health Medicaid |
$97.12
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$145.62
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$111.03
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$118.43
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$103.63
|
|
