|
SA Office Visit - Est. Pt. Detailed (Moderate Complexity 99214)
|
Professional
|
Both
|
$94.76
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
6599214
|
| 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 |
$146.86
|
| Rate for Payer: Humana Medicare |
$136.37
|
| 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 |
$53.43
|
| Rate for Payer: Sunshine Health Medicaid |
$42.74
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$77.38
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$67.70
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$72.54
|
|
|
SA Office Visit - Est. Pt. Detailed (Moderate Complexity 99214)
|
Professional
|
Both
|
$75.19
|
|
|
Service Code
|
CPT T1015
|
| Hospital Charge Code |
166T1015
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$75.19
|
| Rate for Payer: Carelon Medicaid |
$60.00
|
| Rate for Payer: Magellan Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
| Rate for Payer: Sunshine Health FHK |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$57.29
|
|
|
SA Office Visit - Est. Pt. Focus (Low Complexity 99213)
|
Professional
|
Both
|
$75.87
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
6299213
|
| 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 |
$92.92
|
| Rate for Payer: Humana Commercial |
$100.06
|
| Rate for Payer: Humana Medicare |
$92.92
|
| Rate for Payer: Humana Medicare |
$100.06
|
| Rate for Payer: Lucet Commercial |
$48.46
|
| Rate for Payer: Lucet Commercial |
$54.92
|
| Rate for Payer: Lucet Commercial |
$58.15
|
| 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 |
$52.54
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$49.26
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$45.98
|
|
|
SA Office Visit - Est. Pt. Focus (Low Complexity 99213)
|
Professional
|
Both
|
$75.19
|
|
|
Service Code
|
CPT T1015
|
| Hospital Charge Code |
167T1015
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$75.19
|
| Rate for Payer: Carelon Medicaid |
$60.00
|
| Rate for Payer: Magellan Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
| Rate for Payer: Sunshine Health FHK |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$57.29
|
| Rate for Payer: Sunshine Health Medicaid |
$71.61
|
|
|
SA Office Visit - Est. Pt. (High Complexity 99215)
|
Professional
|
Both
|
$75.19
|
|
|
Service Code
|
CPT T1015
|
| Hospital Charge Code |
163T1015
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$75.19
|
| Rate for Payer: Carelon Medicaid |
$60.00
|
| Rate for Payer: Magellan Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
| Rate for Payer: Sunshine Health FHK |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$57.29
|
|
|
SA Office Visit - Est. Pt. (High Complexity 99215)
|
Professional
|
Both
|
$71.61
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
6899215
|
| 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 |
$182.70
|
| Rate for Payer: Humana Commercial |
$196.76
|
| Rate for Payer: Humana Medicare |
$196.76
|
| Rate for Payer: Humana Medicare |
$182.70
|
| Rate for Payer: Lucet Commercial |
$120.14
|
| Rate for Payer: Lucet Commercial |
$127.21
|
| Rate for Payer: Lucet Commercial |
$106.00
|
| 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 |
$107.76
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$100.58
|
|
|
SA Office Visit - Est. Pt. (Minimal 99211)
|
Professional
|
Both
|
$75.19
|
|
|
Service Code
|
CPT T1015
|
| Hospital Charge Code |
164T1015
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$75.19
|
| Rate for Payer: Carelon Medicaid |
$60.00
|
| Rate for Payer: Magellan Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
| Rate for Payer: Sunshine Health FHK |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$57.29
|
| Rate for Payer: Sunshine Health Medicaid |
$71.61
|
|
|
SA Office Visit - Est. Pt. (Minimal 99211)
|
Professional
|
Both
|
$71.61
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
5299211
|
| 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 |
$27.66
|
| Rate for Payer: Humana Commercial |
$25.69
|
| Rate for Payer: Humana Medicare |
$25.69
|
| Rate for Payer: Humana Medicare |
$27.66
|
| Rate for Payer: Lucet Commercial |
$7.25
|
| Rate for Payer: Lucet Commercial |
$6.40
|
| Rate for Payer: Lucet Commercial |
$7.68
|
| 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 |
$14.08
|
| Rate for Payer: Sunshine Health Medicaid |
$17.60
|
| 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 |
$6.94
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$6.07
|
|
|
SA Office Visit - Est. Pt. (Straightforward Complexity 99212)
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
5899212
|
| 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 |
$31.26
|
| Rate for Payer: Lucet Commercial |
$26.05
|
| 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 |
$28.14
|
| Rate for Payer: Sunshine Health Medicaid |
$22.51
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$34.73
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$24.71
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$28.24
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$26.48
|
|
|
SA Office Visit - Est. Pt. (Straightforward Complexity 99212)
|
Professional
|
Both
|
$75.19
|
|
|
Service Code
|
CPT T1015
|
| Hospital Charge Code |
165T1015
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$75.19
|
| Rate for Payer: Carelon Medicaid |
$60.00
|
| Rate for Payer: Magellan Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
| Rate for Payer: Sunshine Health FHK |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$57.29
|
| Rate for Payer: Sunshine Health Medicaid |
$71.61
|
|
|
SA Office Visit - New Pt. Detailed (Low Complexity 99203)
|
Professional
|
Both
|
$75.19
|
|
|
Service Code
|
CPT T1015
|
| Hospital Charge Code |
171T1015
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$75.19
|
| Rate for Payer: Carelon Medicaid |
$60.00
|
| Rate for Payer: Magellan Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
| Rate for Payer: Sunshine Health FHK |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$57.29
|
|
|
SA Office Visit - New Pt. Detailed (Low Complexity 99203)
|
Professional
|
Both
|
$71.61
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
3699203
|
| 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 |
$149.63
|
| Rate for Payer: Humana Medicare |
$138.94
|
| Rate for Payer: Lucet Commercial |
$60.76
|
| Rate for Payer: Lucet Commercial |
$68.86
|
| Rate for Payer: Lucet Commercial |
$72.91
|
| 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 |
$65.88
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$61.76
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$57.64
|
|
|
SA Office Visit - New Pt. (High Complexity 99205)
|
Professional
|
Both
|
$75.19
|
|
|
Service Code
|
CPT 99205 HO
|
| Hospital Charge Code |
4399205
|
| Min. Negotiated Rate |
$75.19 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
|
|
SA Office Visit - New Pt. (High Complexity 99205)
|
Professional
|
Both
|
$75.19
|
|
|
Service Code
|
CPT T1015
|
| Hospital Charge Code |
168T1015
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$75.19
|
| Rate for Payer: Carelon Medicaid |
$60.00
|
| Rate for Payer: Magellan Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
| Rate for Payer: Sunshine Health FHK |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$57.29
|
|
|
SA Office Visit - New Pt. (High Complexity 99205)
|
Professional
|
Both
|
$71.61
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
4299205
|
| 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 |
$282.77
|
| Rate for Payer: Humana Commercial |
$262.57
|
| Rate for Payer: Humana Medicare |
$262.57
|
| Rate for Payer: Humana Medicare |
$282.77
|
| Rate for Payer: Lucet Commercial |
$134.08
|
| Rate for Payer: Lucet Commercial |
$160.90
|
| Rate for Payer: Lucet Commercial |
$151.96
|
| 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 |
$145.39
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$136.30
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$127.22
|
|
|
SA Office Visit - New Pt. (Low Complexity 99202)
|
Professional
|
Both
|
$71.61
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
3399202
|
| 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 |
$35.54
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$33.17
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$37.90
|
|
|
SA Office Visit - New Pt. (Low Complexity 99202)
|
Professional
|
Both
|
$75.19
|
|
|
Service Code
|
CPT T1015
|
| Hospital Charge Code |
169T1015
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$75.19
|
| Rate for Payer: Carelon Medicaid |
$60.00
|
| Rate for Payer: Magellan Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
| Rate for Payer: Sunshine Health FHK |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$57.29
|
| Rate for Payer: Sunshine Health Medicaid |
$71.61
|
|
|
SA Office Visit - New Pt. (Moderate Complexity 99204)
|
Professional
|
Both
|
$75.19
|
|
|
Service Code
|
CPT T1015
|
| Hospital Charge Code |
170T1015
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$75.19
|
| Rate for Payer: Carelon Medicaid |
$60.00
|
| Rate for Payer: Magellan Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
| Rate for Payer: Sunshine Health FHK |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$57.29
|
| Rate for Payer: Sunshine Health Medicaid |
$71.61
|
|
|
SA Office Visit - New Pt. (Moderate Complexity 99204)
|
Professional
|
Both
|
$71.61
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
3999204
|
| 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 |
$228.62
|
| Rate for Payer: Humana Medicare |
$212.28
|
| Rate for Payer: Lucet Commercial |
$118.30
|
| Rate for Payer: Lucet Commercial |
$111.72
|
| Rate for Payer: Lucet Commercial |
$98.58
|
| 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 |
$100.22
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$93.53
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$106.90
|
|
|
SA related medical srvs: medical procedures
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
5499211
|
| 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 |
$7.25
|
| Rate for Payer: Lucet Commercial |
$6.40
|
| Rate for Payer: Lucet Commercial |
$7.68
|
| 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 |
$14.08
|
| Rate for Payer: Sunshine Health Medicaid |
$17.60
|
| 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
|
|
|
SA-related medical srvs: medical procedures-SA - 99211
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
5599211
|
| 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 |
$27.66
|
| Rate for Payer: Humana Commercial |
$25.69
|
| Rate for Payer: Humana Medicare |
$27.66
|
| Rate for Payer: Humana Medicare |
$25.69
|
| Rate for Payer: Lucet Commercial |
$6.40
|
| Rate for Payer: Lucet Commercial |
$7.68
|
| 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 |
$6.94
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$6.07
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$6.50
|
|
|
SA Related Medical Svcs Medical Procedures
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
CPT H0048
|
| Hospital Charge Code |
103H0048
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$10.59 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$10.59
|
| Rate for Payer: Carelon Medicaid |
$10.00
|
| Rate for Payer: Magellan Medicaid |
$10.09
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$10.09
|
| Rate for Payer: Molina Complete Care Marketplace |
$10.09
|
| Rate for Payer: Sunshine Health FHK |
$10.09
|
| Rate for Payer: Sunshine Health Medicaid |
$10.09
|
| Rate for Payer: Sunshine Health Medicaid |
$8.07
|
|
|
SA Related Medical Svcs Medical Procedures 99211
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
5399211
|
| 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 |
$27.66
|
| Rate for Payer: Humana Commercial |
$25.69
|
| Rate for Payer: Humana Medicare |
$25.69
|
| Rate for Payer: Humana Medicare |
$27.66
|
| 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 |
$14.08
|
| Rate for Payer: Sunshine Health Medicaid |
$17.60
|
| Rate for Payer: Sunshine Health MMP/Medicare |
$8.53
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$6.07
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$6.94
|
| Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare |
$6.50
|
|
|
SA Single Panel Drug Test T1015HF
|
Professional
|
Both
|
$10.09
|
|
|
Service Code
|
CPT T1015
|
| Hospital Charge Code |
172T1015
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$75.19 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$75.19
|
| Rate for Payer: Carelon Medicaid |
$60.00
|
| Rate for Payer: Magellan Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$71.61
|
| Rate for Payer: Molina Complete Care Marketplace |
$75.19
|
| Rate for Payer: Sunshine Health FHK |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$71.61
|
| Rate for Payer: Sunshine Health Medicaid |
$57.29
|
|
|
SA Single Panel Drug Test T1015HF
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
CPT T1015 HF
|
| Hospital Charge Code |
173T1015
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$10.59 |
| Rate for Payer: Aetna Better Health CHIP/Medicaid |
$10.59
|
| Rate for Payer: Carelon Medicaid |
$10.00
|
| Rate for Payer: Magellan Medicaid |
$10.09
|
| Rate for Payer: Molina Complete Care CHIP/Medicaid |
$10.09
|
| Rate for Payer: Sunshine Health FHK |
$10.09
|
| Rate for Payer: Sunshine Health Medicaid |
$8.07
|
| Rate for Payer: Sunshine Health Medicaid |
$10.09
|
|
