Aspire Health Partners Inc

All Charges

Charge

Type

Setting

Price

Obesity

Facility

$0.22

Service Code	EAPG 00695
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Sunshine Health Medicaid	$0.22

Obesity counseling, 15 mins

Professional

Both

$80.00

Service Code	CPT G0447
Hospital Charge Code	58G0447
Min. Negotiated Rate	$23.37
Max. Negotiated Rate	$41.22
Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility	$29.21
Rate for Payer: Behavioral Services Network Commercial	$32.13
Rate for Payer: Behavioral Services Network Medicare	$29.21
Rate for Payer: Carelon Medicare	$29.21
Rate for Payer: Lucet Commercial	$23.37
Rate for Payer: Lucet Commercial	$27.75
Rate for Payer: Lucet Commercial	$26.29
Rate for Payer: Molina Complete Care Medicaid/Medicare	$29.21
Rate for Payer: Prime Health Services Workers Comp	$41.22

Observation

Facility

$1.85

Service Code	EAPG 00450
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$1.85
Rate for Payer: Sunshine Health Medicaid	$1.85

Obstetrical Procedures

Facility

$4.06

Service Code	EAPG 00205
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$4.06
Rate for Payer: Sunshine Health Medicaid	$4.06

Obstetrical Ultrasound

Facility

$0.20

Service Code	EAPG 00470
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Sunshine Health Medicaid	$0.20

Occupational Therapy

Facility

$0.85

Service Code	EAPG 00270
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Sunshine Health Medicaid	$0.85

Ocular And Periocular Malignancy

Facility

$0.30

Service Code	EAPG 00556
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Sunshine Health Medicaid	$0.30

Ocular Imaging And Related Services

Facility

$0.11

Service Code	EAPG 00156
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Sunshine Health Medicaid	$0.11

Ocular Reconstructive Procedures W Or W/O Ocular Device

Facility

$6.18

Service Code	EAPG 00241
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$6.18
Rate for Payer: Sunshine Health Medicaid	$6.18

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

Professional

Both

$150.00

Service Code	CPT 99214 GT
Hospital Charge Code	4199214
Min. Negotiated Rate	$53.43
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	$146.86
Rate for Payer: Humana Medicare	$136.37
Rate for Payer: Lucet Commercial	$136.19
Rate for Payer: Lucet Commercial	$123.22
Rate for Payer: Magellan Medicaid	$53.43
Rate for Payer: Prime Health Services Workers Comp	$197.42

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

Professional

Both

$120.00

Service Code	CPT 99213 GT
Hospital Charge Code	4099213
Min. Negotiated Rate	$34.29
Max. Negotiated Rate	$139.81
Rate for Payer: Aetna Better Health CHIP/Medicaid	$36.00
Rate for Payer: Carelon Commercial/Medicare	$35.00
Rate for Payer: Carelon Commercial/Medicare	$51.12
Rate for Payer: Humana Commercial	$92.92
Rate for Payer: Humana Commercial	$100.06
Rate for Payer: Humana Medicare	$100.06
Rate for Payer: Humana Medicare	$92.92
Rate for Payer: Lucet Commercial	$95.89
Rate for Payer: Lucet Commercial	$86.75
Rate for Payer: Magellan Medicaid	$34.29
Rate for Payer: Prime Health Services Workers Comp	$139.81

Office Visit - Est. Pt. (High Complexity)

Professional

Both

$180.00

Service Code	CPT 99215 GT
Hospital Charge Code	4299215
Min. Negotiated Rate	$94.00
Max. Negotiated Rate	$278.85
Rate for Payer: Aetna Better Health CHIP/Medicaid	$98.70
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	$190.69
Rate for Payer: Lucet Commercial	$172.53
Rate for Payer: Magellan Medicaid	$94.00
Rate for Payer: Prime Health Services Workers Comp	$278.85

Office Visit - Est. Pt. (Minimal)

Professional

Both

$60.00

Service Code	CPT 99211
Hospital Charge Code	3899211
Min. Negotiated Rate	$6.74
Max. Negotiated Rate	$34.95
Rate for Payer: Aetna Better Health CHIP/Medicaid	$18.76
Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility	$8.43
Rate for Payer: Behavioral Services Network Commercial	$9.27
Rate for Payer: Behavioral Services Network Medicare	$8.43
Rate for Payer: Carelon Medicare	$8.43
Rate for Payer: Humana Commercial	$25.69
Rate for Payer: Humana Commercial	$27.66
Rate for Payer: Humana Medicare	$25.69
Rate for Payer: Humana Medicare	$27.66
Rate for Payer: Lucet Commercial	$8.01
Rate for Payer: Lucet Commercial	$6.74
Rate for Payer: Lucet Commercial	$7.59
Rate for Payer: Magellan Medicaid	$17.87
Rate for Payer: Molina Complete Care Medicaid/Medicare	$8.43
Rate for Payer: Prime Health Services Workers Comp	$34.95

Office Visit - Est. Pt. (Straightforward Complexity)

Professional

Both

$90.00

Service Code	CPT 99212 GT
Hospital Charge Code	3999212
Min. Negotiated Rate	$28.14
Max. Negotiated Rate	$86.66
Rate for Payer: Aetna Better Health CHIP/Medicaid	$29.55
Rate for Payer: Humana Commercial	$60.09
Rate for Payer: Humana Commercial	$55.80
Rate for Payer: Humana Medicare	$60.09
Rate for Payer: Humana Medicare	$55.80
Rate for Payer: Magellan Medicaid	$28.14
Rate for Payer: Prime Health Services Workers Comp	$86.66

Office Visit - New Pt. Detailed (Low Complexity)

Professional

Both

$150.00

Service Code	CPT 99203 GT
Hospital Charge Code	3599203
Min. Negotiated Rate	$86.04
Max. Negotiated Rate	$172.60
Rate for Payer: Aetna Better Health CHIP/Medicaid	$90.34
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	$118.45
Rate for Payer: Lucet Commercial	$129.73
Rate for Payer: Magellan Medicaid	$86.04
Rate for Payer: Prime Health Services Workers Comp	$172.60

Office Visit - New Pt. (High Complexity)

Professional

Both

$210.00

Service Code	CPT 99205
Hospital Charge Code	3799205
Min. Negotiated Rate	$142.15
Max. Negotiated Rate	$342.51
Rate for Payer: Aetna Better Health CHIP/Medicaid	$178.81
Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility	$177.69
Rate for Payer: Behavioral Services Network Commercial	$195.46
Rate for Payer: Behavioral Services Network Medicare	$177.69
Rate for Payer: Carelon Medicare	$177.69
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	$168.81
Rate for Payer: Lucet Commercial	$257.01
Rate for Payer: Lucet Commercial	$142.15
Rate for Payer: Lucet Commercial	$234.66
Rate for Payer: Magellan Medicaid	$170.30
Rate for Payer: Molina Complete Care Medicaid/Medicare	$177.69
Rate for Payer: Prime Health Services Workers Comp	$342.51

Office Visit - New Pt. (Low Complexity)

Professional

Both

$120.00

Service Code	CPT 99202 GT
Hospital Charge Code	3499202
Min. Negotiated Rate	$55.15
Max. Negotiated Rate	$110.83
Rate for Payer: Aetna Better Health CHIP/Medicaid	$57.91
Rate for Payer: Humana Commercial	$102.26
Rate for Payer: Humana Commercial	$94.95
Rate for Payer: Humana Medicare	$102.26
Rate for Payer: Humana Medicare	$94.95
Rate for Payer: Magellan Medicaid	$55.15
Rate for Payer: Prime Health Services Workers Comp	$110.83

Office Visit - New Pt. (Moderate Complexity)

Professional

Both

$180.00

Service Code	CPT 99204 GT
Hospital Charge Code	3699204
Min. Negotiated Rate	$128.94
Max. Negotiated Rate	$259.28
Rate for Payer: Aetna Better Health CHIP/Medicaid	$135.39
Rate for Payer: Humana Commercial	$212.28
Rate for Payer: Humana Commercial	$228.62
Rate for Payer: Humana Medicare	$228.62
Rate for Payer: Humana Medicare	$212.28
Rate for Payer: Lucet Commercial	$177.53
Rate for Payer: Lucet Commercial	$194.44
Rate for Payer: Magellan Medicaid	$128.94
Rate for Payer: Prime Health Services Workers Comp	$259.28

Open Intracranial And Extracranial Vascular Procedures

Facility

$10.04

Service Code	EAPG 00266
Min. Negotiated Rate	$10.04
Max. Negotiated Rate	$10.04
Rate for Payer: Sunshine Health Medicaid	$10.04

Open Or Percutaneous Treatment Of Fractures

Facility

$11.50

Service Code	EAPG 00043
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$11.50
Rate for Payer: Sunshine Health Medicaid	$11.50

Open Wounds, Punctures And Other Open Traumatic Injuries

Facility

$0.38

Service Code	EAPG 00674
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: Sunshine Health Medicaid	$0.38

Opioid Abuse And Dependence

Facility

$0.32

Service Code	EAPG 00840
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.32
Rate for Payer: Sunshine Health Medicaid	$0.32

Organic Behavioral Health Disturbances

Facility

$0.31

Service Code	EAPG 00827
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.31
Rate for Payer: Sunshine Health Medicaid	$0.31

Organ Or Disease Oriented Panels

Facility

$0.01

Service Code	EAPG 00403
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Sunshine Health Medicaid	$0.01

Osteomyelitis, Septic Arthritis And Other Musculoskeletal Infections

Facility

$0.32

Service Code	EAPG 00654
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.32
Rate for Payer: Sunshine Health Medicaid	$0.32

Know your out-of-pocket cost for care.

All Charges