Aspire Health Partners Inc

All Charges

Charge

Type

Setting

Price

MH 23 Hour Observation Stay

Facility

$900.00

Hospital Charge Code	3
Hospital Revenue Code	762
Min. Negotiated Rate	$238.14
Max. Negotiated Rate	$870.00
Rate for Payer: Cigna/Evernorth Commercial	$720.00
Rate for Payer: Magellan Medicaid	$770.00
Rate for Payer: Molina Complete Care CHIP/Medicaid	$870.00
Rate for Payer: Molina Complete Care Marketplace	$870.00
Rate for Payer: Molina Complete Care Medicare	$870.00
Rate for Payer: Prime Health Services Workers Comp	$238.14

MH Alcohol/Drug Scrn Brief Intrvntion H0050

Professional

Both

$35.00

Service Code	CPT H0050
Hospital Charge Code	106H0050
Min. Negotiated Rate	$24.13
Max. Negotiated Rate	$31.67
Rate for Payer: Aetna Better Health CHIP/Medicaid	$31.67
Rate for Payer: Carelon Medicaid	$28.73
Rate for Payer: Magellan Medicaid	$30.16
Rate for Payer: Molina Complete Care CHIP/Medicaid	$30.16
Rate for Payer: Molina Complete Care Marketplace	$28.73
Rate for Payer: Sunshine Health FHK	$30.16
Rate for Payer: Sunshine Health Medicaid	$30.16
Rate for Payer: Sunshine Health Medicaid	$24.13

MH Bio-Psychosocial 90791

Professional

Both

$180.00

Service Code	CPT 90791
Hospital Charge Code	590791
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	$177.74
Rate for Payer: Humana Commercial	$207.37
Rate for Payer: Humana Commercial	$192.56
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	$131.06
Rate for Payer: Lucet Commercial	$123.78
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

MH Bio-Psychosocial H0031HN

Professional

Both

$60.14

Service Code	CPT H0031 HN
Hospital Charge Code	92H0031
Min. Negotiated Rate	$45.82
Max. Negotiated Rate	$60.14
Rate for Payer: Aetna Better Health CHIP/Medicaid	$60.14
Rate for Payer: Carelon Medicaid	$48.00
Rate for Payer: Magellan Medicaid	$57.28
Rate for Payer: Molina Complete Care CHIP/Medicaid	$57.28
Rate for Payer: Sunshine Health FHK	$57.28
Rate for Payer: Sunshine Health Medicaid	$57.28
Rate for Payer: Sunshine Health Medicaid	$45.82

MH Bio-Psychosocial H0031HN

Professional

Both

$57.28

Service Code	CPT H0031
Hospital Charge Code	91H0031
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$18.80
Rate for Payer: Aetna Better Health CHIP/Medicaid	$18.80
Rate for Payer: Carelon Medicaid	$15.00
Rate for Payer: Magellan Medicaid	$17.90
Rate for Payer: Molina Complete Care CHIP/Medicaid	$17.90
Rate for Payer: Sunshine Health FHK	$17.90
Rate for Payer: Sunshine Health Medicaid	$14.32
Rate for Payer: Sunshine Health Medicaid	$17.90

MH Brief Behavioral Status Exam - H2010

Professional

Both

$60.00

Service Code	CPT H2010 HO
Hospital Charge Code	118H2010
Min. Negotiated Rate	$11.83
Max. Negotiated Rate	$15.53
Rate for Payer: Aetna Better Health CHIP/Medicaid	$15.53
Rate for Payer: Carelon Medicaid	$14.66
Rate for Payer: Magellan Medicaid	$14.79
Rate for Payer: Molina Complete Care CHIP/Medicaid	$14.79
Rate for Payer: Molina Complete Care Marketplace	$14.79
Rate for Payer: Sunshine Health FHK	$14.79
Rate for Payer: Sunshine Health Medicaid	$14.79
Rate for Payer: Sunshine Health Medicaid	$11.83

MH ETG T1015HF

Professional

Both

$48.00

Service Code	CPT T1015 HF
Hospital Charge Code	144T1015
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

MH ETG T1015HF

Professional

Both

$10.09

Service Code	CPT T1015
Hospital Charge Code	143T1015
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

MH Family Therapy 90847

Professional

Both

$86.16

Service Code	CPT 90847
Hospital Charge Code	2790847
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$159.67
Rate for Payer: Aetna Better Health CHIP/Medicaid	$81.06
Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility	$100.23
Rate for Payer: Behavioral Services Network Medicare	$100.23
Rate for Payer: Carelon Commercial/Medicare	$60.00
Rate for Payer: Carelon Commercial/Medicare	$55.00
Rate for Payer: Carelon Medicare	$100.23
Rate for Payer: Humana Commercial	$105.41
Rate for Payer: Humana Commercial	$114.18
Rate for Payer: Humana Commercial	$122.98
Rate for Payer: Humana Medicare	$105.41
Rate for Payer: Humana Medicare	$114.18
Rate for Payer: Humana Medicare	$122.98
Rate for Payer: Lucet Commercial	$85.20
Rate for Payer: Lucet Commercial	$90.21
Rate for Payer: Lucet Commercial	$75.17
Rate for Payer: Magellan Medicaid	$77.20
Rate for Payer: Molina Complete Care CHIP/Medicaid	$77.20
Rate for Payer: Molina Complete Care Medicare	$100.23
Rate for Payer: Prime Health Services Workers Comp	$159.67
Rate for Payer: Sunshine Health FHK	$77.20
Rate for Payer: Sunshine Health Medicaid	$61.76
Rate for Payer: Sunshine Health Medicaid	$77.20
Rate for Payer: Sunshine Health MMP/Medicare	$100.23
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$81.52
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$71.33
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$76.42

MH Family Therapy H2019HR

Professional

Both

$22.96

Service Code	CPT H2019 HR
Hospital Charge Code	130H2019
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$22.96
Rate for Payer: Aetna Better Health CHIP/Medicaid	$22.96
Rate for Payer: Carelon Medicaid	$18.33
Rate for Payer: Magellan Medicaid	$21.87
Rate for Payer: Molina Complete Care CHIP/Medicaid	$21.87
Rate for Payer: Molina Complete Care Marketplace	$22.96
Rate for Payer: Sunshine Health FHK	$21.87
Rate for Payer: Sunshine Health Medicaid	$17.50
Rate for Payer: Sunshine Health Medicaid	$21.87

MH Family Therapy H2019HR

Professional

Both

$21.87

Service Code	CPT H2019
Hospital Charge Code	129H2019
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$38.65
Rate for Payer: Aetna Better Health CHIP/Medicaid	$18.80
Rate for Payer: Carelon Medicaid	$15.00
Rate for Payer: Magellan Medicaid	$17.90
Rate for Payer: Molina Complete Care CHIP/Medicaid	$17.90
Rate for Payer: Sunshine Health FHK	$17.90
Rate for Payer: Sunshine Health Medicaid	$14.32
Rate for Payer: Sunshine Health Medicaid	$17.90
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$33.82
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$36.23
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$38.65

MH In-Depth Assessment Established Client

Professional

Both

$100.88

Service Code	CPT H0031
Hospital Charge Code	93H0031
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$18.80
Rate for Payer: Aetna Better Health CHIP/Medicaid	$18.80
Rate for Payer: Carelon Medicaid	$15.00
Rate for Payer: Magellan Medicaid	$17.90
Rate for Payer: Molina Complete Care CHIP/Medicaid	$17.90
Rate for Payer: Sunshine Health FHK	$17.90
Rate for Payer: Sunshine Health Medicaid	$17.90
Rate for Payer: Sunshine Health Medicaid	$14.32

MH In-Depth Assessment Established Client

Professional

Both

$210.00

Service Code	CPT H0031 TS
Hospital Charge Code	94H0031
Min. Negotiated Rate	$80.70
Max. Negotiated Rate	$105.92
Rate for Payer: Aetna Better Health CHIP/Medicaid	$105.92
Rate for Payer: Carelon Medicaid	$100.00
Rate for Payer: Magellan Medicaid	$100.88
Rate for Payer: Molina Complete Care CHIP/Medicaid	$100.88
Rate for Payer: Sunshine Health FHK	$100.88
Rate for Payer: Sunshine Health Medicaid	$100.88
Rate for Payer: Sunshine Health Medicaid	$80.70

MH In-Depth Assessment New Client H0031HO

Professional

Both

$126.11

Service Code	CPT H0031
Hospital Charge Code	95H0031
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$18.80
Rate for Payer: Aetna Better Health CHIP/Medicaid	$18.80
Rate for Payer: Carelon Medicaid	$15.00
Rate for Payer: Magellan Medicaid	$17.90
Rate for Payer: Molina Complete Care CHIP/Medicaid	$17.90
Rate for Payer: Sunshine Health FHK	$17.90
Rate for Payer: Sunshine Health Medicaid	$14.32
Rate for Payer: Sunshine Health Medicaid	$17.90

MH In-Depth Assessment New Client H0031HO

Professional

Both

$240.00

Service Code	CPT H0031 HO
Hospital Charge Code	96H0031
Min. Negotiated Rate	$100.89
Max. Negotiated Rate	$132.42
Rate for Payer: Aetna Better Health CHIP/Medicaid	$132.42
Rate for Payer: Carelon Medicaid	$125.00
Rate for Payer: Magellan Medicaid	$126.11
Rate for Payer: Molina Complete Care CHIP/Medicaid	$126.11
Rate for Payer: Molina Complete Care Marketplace	$126.11
Rate for Payer: Sunshine Health FHK	$126.11
Rate for Payer: Sunshine Health Medicaid	$126.11
Rate for Payer: Sunshine Health Medicaid	$100.89

MH Inpatient R&B

Facility

$1,200.00

Hospital Charge Code	2
Hospital Revenue Code	124
Min. Negotiated Rate	$317.52
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Gatekeeper	$713.00
Rate for Payer: Aetna Medicare	$713.00
Rate for Payer: Aetna Non-Gatekeeper	$713.00
Rate for Payer: Behavioral Services Network Medicaid	$850.00
Rate for Payer: Carelon Commercial/Medicare	$700.00
Rate for Payer: Carelon Medicaid	$775.00
Rate for Payer: Cigna/Evernorth Commercial	$711.00
Rate for Payer: Humana Commercial	$646.00
Rate for Payer: Lucet Commercial	$650.00
Rate for Payer: Magellan Medicaid	$700.00
Rate for Payer: Molina Complete Care CHIP/Medicaid	$850.00
Rate for Payer: Molina Complete Care Marketplace	$850.00
Rate for Payer: Molina Complete Care Medicare	$850.00
Rate for Payer: Prime Health Services Workers Comp	$317.52
Rate for Payer: Sunshine Health FHK	$586.43
Rate for Payer: Sunshine Health Medicaid	$700.00
Rate for Payer: Tricare Military (Humana Behavioral Health) Tricare	$764.40
Rate for Payer: United Behavioral Health Care/Optum Commercial/Medicare	$615.00
Rate for Payer: United Behavioral Health Care/Optum FHK/Medicaid	$589.00

MH Inpatient R&B

Professional

Both

$700.00

Service Code	CPT S9485
Hospital Charge Code	138S9485
Min. Negotiated Rate	$700.00
Max. Negotiated Rate	$700.00
Rate for Payer: Molina Complete Care Marketplace	$700.00

MH Inpatient Room & Board

Facility

$1,200.00

Hospital Charge Code	183
Hospital Revenue Code	124
Min. Negotiated Rate	$317.52
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Gatekeeper	$713.00
Rate for Payer: Aetna Medicare	$713.00
Rate for Payer: Aetna Non-Gatekeeper	$713.00
Rate for Payer: Behavioral Services Network Medicaid	$850.00
Rate for Payer: Carelon Commercial/Medicare	$700.00
Rate for Payer: Carelon Medicaid	$775.00
Rate for Payer: Cigna/Evernorth Commercial	$711.00
Rate for Payer: Humana Commercial	$646.00
Rate for Payer: Lucet Commercial	$650.00
Rate for Payer: Magellan Medicaid	$700.00
Rate for Payer: Molina Complete Care CHIP/Medicaid	$850.00
Rate for Payer: Molina Complete Care Marketplace	$850.00
Rate for Payer: Molina Complete Care Medicare	$850.00
Rate for Payer: Prime Health Services Workers Comp	$317.52
Rate for Payer: Sunshine Health FHK	$586.43
Rate for Payer: Sunshine Health Medicaid	$700.00
Rate for Payer: Tricare Military (Humana Behavioral Health) Tricare	$764.40
Rate for Payer: United Behavioral Health Care/Optum Commercial/Medicare	$615.00
Rate for Payer: United Behavioral Health Care/Optum FHK/Medicaid	$589.00

MH Intensive Team Case Management

Professional

Both

$12.07

Service Code	CPT T1017
Hospital Charge Code	179T1017
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Carelon Medicaid	$12.00

MH Limited Functional Assessment H0031

Professional

Both

$48.00

Service Code	CPT H0031
Hospital Charge Code	97H0031
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$18.80
Rate for Payer: Aetna Better Health CHIP/Medicaid	$18.80
Rate for Payer: Carelon Medicaid	$15.00
Rate for Payer: Magellan Medicaid	$17.90
Rate for Payer: Molina Complete Care CHIP/Medicaid	$17.90
Rate for Payer: Sunshine Health FHK	$17.90
Rate for Payer: Sunshine Health Medicaid	$14.32
Rate for Payer: Sunshine Health Medicaid	$17.90

MH Office Visit - Est. Pt. Detailed (Moderate Complexity 99214)

Professional

Both

$94.76

Service Code	CPT 99214
Hospital Charge Code	6399214
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	$136.37
Rate for Payer: Humana Commercial	$146.86
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	$67.70
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$77.38
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$72.54

MH Office Visit - Est. Pt. Detailed (Moderate Complexity 99214)

Professional

Both

$75.19

Service Code	CPT T1015
Hospital Charge Code	149T1015
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

MH Office Visit - Est. Pt. Focus (Low Complexity 99213)

Professional

Both

$75.19

Service Code	CPT T1015
Hospital Charge Code	150T1015
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

MH Office Visit - Est. Pt. Focus (Low Complexity 99213)

Professional

Both

$75.87

Service Code	CPT 99213
Hospital Charge Code	6099213
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	$100.06
Rate for Payer: Humana Medicare	$92.92
Rate for Payer: Lucet Commercial	$48.46
Rate for Payer: Lucet Commercial	$58.15
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	$45.98
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$52.54
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$49.26

MH Office Visit - Est. Pt. (High Complexity 99215)

Professional

Both

$75.19

Service Code	CPT T1015
Hospital Charge Code	145T1015
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

Know your out-of-pocket cost for care.

All Charges