|
Class Vi Pharmacotherapy
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
EAPG 00440
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Sunshine Health Medicaid |
$1.04
|
|
|
Class V Pharmacotherapy
|
Facility
|
OP
|
$0.93
|
|
|
Service Code
|
EAPG 00439
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Sunshine Health Medicaid |
$0.93
|
|
|
Class X Combined Chemotherapy And Pharmacotherapy
|
Facility
|
OP
|
$8.75
|
|
|
Service Code
|
EAPG 00462
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$8.75 |
| Rate for Payer: Sunshine Health Medicaid |
$8.75
|
|
|
Class Xi Combined Chemotherapy And Pharmacotherapy
|
Facility
|
OP
|
$9.21
|
|
|
Service Code
|
EAPG 00463
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$9.21 |
| Rate for Payer: Sunshine Health Medicaid |
$9.21
|
|
|
Class Xii Combined Chemotherapy And Pharmacotherapy
|
Facility
|
OP
|
$15.27
|
|
|
Service Code
|
EAPG 00464
|
| Min. Negotiated Rate |
$15.27 |
| Max. Negotiated Rate |
$15.27 |
| Rate for Payer: Sunshine Health Medicaid |
$15.27
|
|
|
Class Xiii Combined Chemotherapy And Pharmacotherapy
|
Facility
|
OP
|
$34.34
|
|
|
Service Code
|
EAPG 00465
|
| Min. Negotiated Rate |
$34.34 |
| Max. Negotiated Rate |
$34.34 |
| Rate for Payer: Sunshine Health Medicaid |
$34.34
|
|
|
Class Xiv Combined Chemotherapy And Pharmacotherapy
|
Facility
|
OP
|
$49.36
|
|
|
Service Code
|
EAPG 00466
|
| Min. Negotiated Rate |
$49.36 |
| Max. Negotiated Rate |
$49.36 |
| Rate for Payer: Sunshine Health Medicaid |
$49.36
|
|
|
Cleft Lip And Palate Repair
|
Facility
|
OP
|
$6.26
|
|
|
Service Code
|
EAPG 00262
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$6.26 |
| Rate for Payer: Sunshine Health Medicaid |
$6.26
|
|
|
Closed Treatment Fx And Dislocation
|
Facility
|
OP
|
$1.06
|
|
|
Service Code
|
EAPG 00041
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Sunshine Health Medicaid |
$1.06
|
|
|
Clubhouse Services
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
CPT H2030
|
| Hospital Charge Code |
88H2030
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.04 |
| Rate for Payer: Carelon Medicaid |
$5.00
|
| Rate for Payer: Molina Complete Care Marketplace |
$5.04
|
|
|
Coagulation And Platelet Disorders And Congenital Factor Deficiencies
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
EAPG 00781
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Sunshine Health Medicaid |
$0.30
|
|
|
Cocaine Abuse And Dependence
|
Facility
|
OP
|
$0.61
|
|
|
Service Code
|
EAPG 00841
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Sunshine Health Medicaid |
$0.61
|
|
|
Cochlear Device Implantation
|
Facility
|
OP
|
$49.37
|
|
|
Service Code
|
EAPG 00250
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$49.37 |
| Rate for Payer: Sunshine Health Medicaid |
$49.37
|
|
|
Complex Blood Collection Services
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
EAPG 00494
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Sunshine Health Medicaid |
$0.15
|
|
|
Complex CCM, 60 minutes
|
Professional
|
Both
|
$396.00
|
|
|
Service Code
|
CPT 99487
|
| Hospital Charge Code |
4699487
|
| Min. Negotiated Rate |
$70.02 |
| Max. Negotiated Rate |
$205.30 |
| Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility |
$87.52
|
| Rate for Payer: Behavioral Services Network Commercial |
$96.27
|
| Rate for Payer: Behavioral Services Network Medicare |
$87.52
|
| Rate for Payer: Carelon Medicare |
$87.52
|
| Rate for Payer: Lucet Commercial |
$83.14
|
| Rate for Payer: Lucet Commercial |
$70.02
|
| Rate for Payer: Lucet Commercial |
$78.77
|
| Rate for Payer: Molina Complete Care Medicaid/Medicare |
$87.52
|
| Rate for Payer: Prime Health Services Workers Comp |
$205.30
|
|
|
Complex Kidney And Urinary Tract Infections
|
Facility
|
OP
|
$0.55
|
|
|
Service Code
|
EAPG 00723
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Sunshine Health Medicaid |
$0.55
|
|
|
Complex Wound Repair And Treatment
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
EAPG 00018
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Sunshine Health Medicaid |
$2.10
|
|
|
Complications Of Treatment Affecting Pregnancy
|
Facility
|
OP
|
$0.83
|
|
|
Service Code
|
EAPG 00767
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Sunshine Health Medicaid |
$0.83
|
|
|
Comprehensive Cardiac Electrophysiologic Procedures With Ablation
|
Facility
|
OP
|
$36.01
|
|
|
Service Code
|
EAPG 00082
|
| Min. Negotiated Rate |
$36.01 |
| Max. Negotiated Rate |
$36.01 |
| Rate for Payer: Sunshine Health Medicaid |
$36.01
|
|
|
Computed Tomographic Angiography
|
Facility
|
OP
|
$0.83
|
|
|
Service Code
|
EAPG 00302
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Sunshine Health Medicaid |
$0.83
|
|
|
Computed Tomography- Other
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
EAPG 00301
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Sunshine Health Medicaid |
$0.47
|
|
|
Conjunctivitis
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
EAPG 00555
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Sunshine Health Medicaid |
$0.25
|
|
|
Connective Tissue Diagnoses
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
EAPG 00655
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Sunshine Health Medicaid |
$0.26
|
|
|
Constipation
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
EAPG 00630
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Sunshine Health Medicaid |
$0.41
|
|
|
Contraceptive Management
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
EAPG 00875
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Sunshine Health Medicaid |
$0.32
|
|
