|
Cholecystectomy And Related Biliary Procedures
|
Facility
|
OP
|
$7.79
|
|
|
Service Code
|
EAPG 00107
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$7.79 |
| Rate for Payer: Sunshine Health Medicaid |
$7.79
|
|
|
Cholecystitis
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
EAPG 00638
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Sunshine Health Medicaid |
$0.62
|
|
|
Chronic Care management (CCM) 20 minutes
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
4799490
|
| Min. Negotiated Rate |
$38.09 |
| Max. Negotiated Rate |
$96.64 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$39.99
|
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$47.96
|
| Rate for Payer: Behavioral Services Network Commercial |
$52.76
|
| Rate for Payer: Behavioral Services Network Medicare |
$47.96
|
| Rate for Payer: Carelon Medicare |
$47.96
|
| Rate for Payer: Lucet Commercial |
$43.16
|
| Rate for Payer: Lucet Commercial |
$38.37
|
| Rate for Payer: Lucet Commercial |
$45.56
|
| Rate for Payer: Magellan Medicaid |
$38.09
|
| Rate for Payer: Molina Complete Care Medicaid/Medicare |
$47.96
|
| Rate for Payer: Prime Health Services Workers Comp |
$96.64
|
|
|
Chronic Kidney Disease
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
EAPG 00720
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Sunshine Health Medicaid |
$0.29
|
|
|
Chronic Obstructive Pulmonary Disease
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
EAPG 00574
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Sunshine Health Medicaid |
$0.54
|
|
|
Class I Blood Products
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
EAPG 02061
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Sunshine Health Medicaid |
$0.25
|
|
|
Class I Brachytherapy Sources
|
Facility
|
OP
|
$0.48
|
|
|
Service Code
|
EAPG 00335
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Sunshine Health Medicaid |
$0.48
|
|
|
Class Ii Blood Products
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
EAPG 02062
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Sunshine Health Medicaid |
$0.59
|
|
|
Class Ii Brachytherapy Sources
|
Facility
|
OP
|
$5.54
|
|
|
Service Code
|
EAPG 00336
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$5.54 |
| Rate for Payer: Sunshine Health Medicaid |
$5.54
|
|
|
Class Ii Chemotherapy Drugs
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
EAPG 00431
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Sunshine Health Medicaid |
$0.08
|
|
|
Class Iii Brachytherapy Sources
|
Facility
|
OP
|
$23.78
|
|
|
Service Code
|
EAPG 00337
|
| Min. Negotiated Rate |
$23.78 |
| Max. Negotiated Rate |
$23.78 |
| Rate for Payer: Sunshine Health Medicaid |
$23.78
|
|
|
Class Iii Chemotherapy Drugs
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
EAPG 00432
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Sunshine Health Medicaid |
$0.26
|
|
|
Class Iii Pharmacotherapy
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
EAPG 00437
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Sunshine Health Medicaid |
$0.25
|
|
|
Class Iii Therapeutic Radiopharmaceuticals
|
Facility
|
OP
|
$27.56
|
|
|
Service Code
|
EAPG 00245
|
| Min. Negotiated Rate |
$27.56 |
| Max. Negotiated Rate |
$27.56 |
| Rate for Payer: Sunshine Health Medicaid |
$27.56
|
|
|
Class Ii Pharmacotherapy
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
EAPG 00436
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Sunshine Health Medicaid |
$0.21
|
|
|
Class Ii Therapeutic Radiopharmaceuticals
|
Facility
|
OP
|
$1.57
|
|
|
Service Code
|
EAPG 00244
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Sunshine Health Medicaid |
$1.57
|
|
|
Class Iv Chemotherapy Drugs
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
EAPG 00433
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Sunshine Health Medicaid |
$0.27
|
|
|
Class Iv Pharmacotherapy
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
EAPG 00438
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Sunshine Health Medicaid |
$0.33
|
|
|
Class Iv Therapeutic Radiopharmaceuticals
|
Facility
|
OP
|
$70.05
|
|
|
Service Code
|
EAPG 00246
|
| Min. Negotiated Rate |
$70.05 |
| Max. Negotiated Rate |
$70.05 |
| Rate for Payer: Sunshine Health Medicaid |
$70.05
|
|
|
Class Ix Combined Chemotherapy And Pharmacotherapy
|
Facility
|
OP
|
$3.67
|
|
|
Service Code
|
EAPG 00461
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Sunshine Health Medicaid |
$3.67
|
|
|
Class V Chemotherapy Drugs
|
Facility
|
OP
|
$0.70
|
|
|
Service Code
|
EAPG 00434
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Sunshine Health Medicaid |
$0.70
|
|
|
Class Vi Chemotherapy Drugs
|
Facility
|
OP
|
$1.17
|
|
|
Service Code
|
EAPG 00441
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: Sunshine Health Medicaid |
$1.17
|
|
|
Class Vii Chemotherapy Drugs
|
Facility
|
OP
|
$2.43
|
|
|
Service Code
|
EAPG 00443
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Sunshine Health Medicaid |
$2.43
|
|
|
Class Viii Combined Chemotherapy And Pharmacotherapy
|
Facility
|
OP
|
$2.55
|
|
|
Service Code
|
EAPG 00460
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Sunshine Health Medicaid |
$2.55
|
|
|
Class Vii Pharmacotherapy
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
EAPG 00444
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Sunshine Health Medicaid |
$1.76
|
|
