Aspire Health Partners Inc

All Charges

Charge

Type

Setting

Price

Psychiatric Evaluation by Physician H2000

Professional

Both

$250.63

Service Code	CPT H2000
Hospital Charge Code	114H2000
Min. Negotiated Rate	$24.82
Max. Negotiated Rate	$32.58
Rate for Payer: Aetna Better Health CHIP/Medicaid	$32.58
Rate for Payer: Carelon Medicaid	$26.00
Rate for Payer: Magellan Medicaid	$31.03
Rate for Payer: Molina Complete Care CHIP/Medicaid	$31.03
Rate for Payer: Sunshine Health FHK	$31.03
Rate for Payer: Sunshine Health Medicaid	$24.82
Rate for Payer: Sunshine Health Medicaid	$31.03

Psychiatric Evaluation by Physician H2000

Professional

Both

$263.16

Service Code	CPT H2000 HP
Hospital Charge Code	115H2000
Min. Negotiated Rate	$200.50
Max. Negotiated Rate	$263.16
Rate for Payer: Aetna Better Health CHIP/Medicaid	$263.16
Rate for Payer: Carelon Medicaid	$210.00
Rate for Payer: Magellan Medicaid	$250.63
Rate for Payer: Molina Complete Care CHIP/Medicaid	$250.63
Rate for Payer: Molina Complete Care Marketplace	$263.16
Rate for Payer: Sunshine Health FHK	$250.63
Rate for Payer: Sunshine Health Medicaid	$200.50
Rate for Payer: Sunshine Health Medicaid	$250.63

Psychiatric Evaluation by Physician H2000HP

Professional

Both

$263.16

Service Code	CPT H2000 HP
Hospital Charge Code	116H2000
Min. Negotiated Rate	$200.50
Max. Negotiated Rate	$263.16
Rate for Payer: Aetna Better Health CHIP/Medicaid	$263.16
Rate for Payer: Carelon Medicaid	$210.00
Rate for Payer: Magellan Medicaid	$250.63
Rate for Payer: Molina Complete Care CHIP/Medicaid	$250.63
Rate for Payer: Molina Complete Care Marketplace	$263.16
Rate for Payer: Sunshine Health FHK	$250.63
Rate for Payer: Sunshine Health Medicaid	$200.50
Rate for Payer: Sunshine Health Medicaid	$250.63

Psychosocial Rehab

Professional

Both

$24.00

Service Code	CPT H2017
Hospital Charge Code	123H2017
Min. Negotiated Rate	$7.26
Max. Negotiated Rate	$9.53
Rate for Payer: Aetna Better Health CHIP/Medicaid	$9.53
Rate for Payer: Carelon Medicaid	$9.00
Rate for Payer: Magellan Medicaid	$9.08
Rate for Payer: Molina Complete Care CHIP/Medicaid	$9.08
Rate for Payer: Molina Complete Care Marketplace	$9.08
Rate for Payer: Sunshine Health FHK	$9.08
Rate for Payer: Sunshine Health Medicaid	$7.26
Rate for Payer: Sunshine Health Medicaid	$9.08

Psychosocial Rehabilitative Services - H2017

Professional

Both

$9.53

Service Code	CPT H2017
Hospital Charge Code	124H2017
Min. Negotiated Rate	$7.26
Max. Negotiated Rate	$9.53
Rate for Payer: Aetna Better Health CHIP/Medicaid	$9.53
Rate for Payer: Carelon Medicaid	$9.00
Rate for Payer: Magellan Medicaid	$9.08
Rate for Payer: Molina Complete Care CHIP/Medicaid	$9.08
Rate for Payer: Molina Complete Care Marketplace	$9.08
Rate for Payer: Sunshine Health FHK	$9.08
Rate for Payer: Sunshine Health Medicaid	$9.08
Rate for Payer: Sunshine Health Medicaid	$7.26

SA Alcohol and/or Drug Screening - H0049

Professional

Both

$25.00

Service Code	CPT H0049
Hospital Charge Code	105H0049
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$24.94
Rate for Payer: Aetna Better Health CHIP/Medicaid	$18.83
Rate for Payer: Carelon Medicaid	$17.08
Rate for Payer: Magellan Medicaid	$17.93
Rate for Payer: Molina Complete Care CHIP/Medicaid	$17.93
Rate for Payer: Molina Complete Care Marketplace	$17.08
Rate for Payer: Sunshine Health FHK	$17.93
Rate for Payer: Sunshine Health Medicaid	$14.34
Rate for Payer: Sunshine Health Medicaid	$17.93
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$23.38
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$21.82
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$24.94

SA Alcohol/Drug Scrn Brief Intrvntion H0050

Professional

Both

$35.00

Service Code	CPT H0050
Hospital Charge Code	107H0050
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

SA Bio-Psychosocial 90791

Professional

Both

$180.00

Service Code	CPT 90791
Hospital Charge Code	1190791
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	$192.56
Rate for Payer: Humana Commercial	$207.37
Rate for Payer: Humana Medicare	$177.74
Rate for Payer: Humana Medicare	$192.56
Rate for Payer: Humana Medicare	$207.37
Rate for Payer: Lucet Commercial	$109.22
Rate for Payer: Lucet Commercial	$123.78
Rate for Payer: Lucet Commercial	$131.06
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

SA Bio-Psychosocial 90791HN

Professional

Both

$150.00

Service Code	CPT 90791
Hospital Charge Code	1290791
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	$192.56
Rate for Payer: Humana Commercial	$207.37
Rate for Payer: Humana Commercial	$177.74
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	$123.78
Rate for Payer: Lucet Commercial	$109.22
Rate for Payer: Lucet Commercial	$131.06
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	$97.12
Rate for Payer: Sunshine Health Medicaid	$121.40
Rate for Payer: Sunshine Health MMP/Medicare	$145.62
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$118.43
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$111.03
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$103.63

SA Bio-Psychosocial H0001HN

Professional

Both

$57.28

Service Code	CPT H0001
Hospital Charge Code	77H0001
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$15.89
Rate for Payer: Aetna Better Health CHIP/Medicaid	$15.89
Rate for Payer: Carelon Medicaid	$15.00
Rate for Payer: Magellan Medicaid	$15.13
Rate for Payer: Molina Complete Care CHIP/Medicaid	$15.13
Rate for Payer: Sunshine Health FHK	$15.13
Rate for Payer: Sunshine Health Medicaid	$12.10
Rate for Payer: Sunshine Health Medicaid	$15.13

SA Bio-Psychosocial H0001HN

Professional

Both

$60.14

Service Code	CPT H0001 HN
Hospital Charge Code	78H0001
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	$45.82
Rate for Payer: Sunshine Health Medicaid	$57.28

SA Brief Behavioral Status Exam - H2010

Professional

Both

$60.00

Service Code	CPT H2010 HO
Hospital Charge Code	120H2010
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	$11.83
Rate for Payer: Sunshine Health Medicaid	$14.79

SA ETG T1015HF

Professional

Both

$48.00

Service Code	CPT T1015 HF
Hospital Charge Code	162T1015
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

SA ETG T1015HF

Professional

Both

$10.09

Service Code	CPT T1015
Hospital Charge Code	161T1015
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 Family Therapy 90847

Professional

Both

$86.16

Service Code	CPT 90847
Hospital Charge Code	2890847
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	$55.00
Rate for Payer: Carelon Commercial/Medicare	$60.00
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	$122.98
Rate for Payer: Humana Medicare	$114.18
Rate for Payer: Humana Medicare	$105.41
Rate for Payer: Lucet Commercial	$90.21
Rate for Payer: Lucet Commercial	$85.20
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

SA Family Therapy H2019HR

Professional

Both

$22.96

Service Code	CPT H2019 HR
Hospital Charge Code	132H2019
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	$21.87
Rate for Payer: Sunshine Health Medicaid	$17.50

SA Family Therapy H2019HR

Professional

Both

$21.87

Service Code	CPT H2019
Hospital Charge Code	131H2019
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	$17.90
Rate for Payer: Sunshine Health Medicaid	$14.32
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$38.65
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$33.82
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$36.23

SA In-Depth Assessment Established Client

Professional

Both

$100.00

Service Code	CPT H0001
Hospital Charge Code	79H0001
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$15.89
Rate for Payer: Aetna Better Health CHIP/Medicaid	$15.89
Rate for Payer: Carelon Medicaid	$15.00
Rate for Payer: Magellan Medicaid	$15.13
Rate for Payer: Molina Complete Care CHIP/Medicaid	$15.13
Rate for Payer: Sunshine Health FHK	$15.13
Rate for Payer: Sunshine Health Medicaid	$15.13
Rate for Payer: Sunshine Health Medicaid	$12.10

SA In-Depth Assessment Established Client

Professional

Both

$240.00

Service Code	CPT H0001 TS
Hospital Charge Code	80H0001
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

SA In-Depth Assessment New Client

Professional

Both

$126.11

Service Code	CPT H0001
Hospital Charge Code	81H0001
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$15.89
Rate for Payer: Aetna Better Health CHIP/Medicaid	$15.89
Rate for Payer: Carelon Medicaid	$15.00
Rate for Payer: Magellan Medicaid	$15.13
Rate for Payer: Molina Complete Care CHIP/Medicaid	$15.13
Rate for Payer: Sunshine Health FHK	$15.13
Rate for Payer: Sunshine Health Medicaid	$15.13
Rate for Payer: Sunshine Health Medicaid	$12.10

SA In-Depth Assessment New Client

Professional

Both

$240.00

Service Code	CPT H0001 HO
Hospital Charge Code	82H0001
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	$100.89
Rate for Payer: Sunshine Health Medicaid	$126.11

SA Inpatient R&B

Professional

Both

$700.00

Service Code	CPT S9485
Hospital Charge Code	139S9485
Min. Negotiated Rate	$700.00
Max. Negotiated Rate	$700.00
Rate for Payer: Molina Complete Care Marketplace	$700.00

SA IOP Group Therapy

Professional

Both

$30.00

Service Code	CPT 90853
Hospital Charge Code	3090853
Min. Negotiated Rate	$16.70
Max. Negotiated Rate	$55.00
Rate for Payer: Aetna Better Health CHIP/Medicaid	$21.91
Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility	$23.72
Rate for Payer: Behavioral Services Network Medicare	$23.72
Rate for Payer: Carelon Commercial/Medicare	$55.00
Rate for Payer: Carelon Commercial/Medicare	$35.00
Rate for Payer: Carelon Medicare	$23.72
Rate for Payer: Humana Commercial	$34.23
Rate for Payer: Humana Commercial	$31.78
Rate for Payer: Humana Commercial	$29.34
Rate for Payer: Humana Medicare	$31.78
Rate for Payer: Humana Medicare	$34.23
Rate for Payer: Humana Medicare	$29.34
Rate for Payer: Lucet Commercial	$21.35
Rate for Payer: Lucet Commercial	$20.16
Rate for Payer: Lucet Commercial	$17.79
Rate for Payer: Magellan Medicaid	$20.87
Rate for Payer: Molina Complete Care CHIP/Medicaid	$20.87
Rate for Payer: Molina Complete Care Medicare	$23.72
Rate for Payer: Prime Health Services Workers Comp	$42.92
Rate for Payer: Sunshine Health FHK	$20.87
Rate for Payer: Sunshine Health Medicaid	$16.70
Rate for Payer: Sunshine Health Medicaid	$20.87
Rate for Payer: Sunshine Health MMP/Medicare	$23.72
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$19.30
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$18.09
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$16.88

SA Limited Functional Assessment H0001

Professional

Both

$15.13

Service Code	CPT H0001 GT
Hospital Charge Code	84H0001
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Carelon Medicaid	$15.00

SA Limited Functional Assessment H0001

Professional

Both

$48.00

Service Code	CPT H0001
Hospital Charge Code	83H0001
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$15.89
Rate for Payer: Aetna Better Health CHIP/Medicaid	$15.89
Rate for Payer: Carelon Medicaid	$15.00
Rate for Payer: Magellan Medicaid	$15.13
Rate for Payer: Molina Complete Care CHIP/Medicaid	$15.13
Rate for Payer: Sunshine Health FHK	$15.13
Rate for Payer: Sunshine Health Medicaid	$15.13
Rate for Payer: Sunshine Health Medicaid	$12.10

Know your out-of-pocket cost for care.

All Charges