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Charge Type Price  
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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