Aspire Health Partners Inc

All Charges

Charge

Type

Setting

Price

SA Substance Test T1015HF

Professional

Both

$10.09

Service Code	CPT T1015
Hospital Charge Code	174T1015
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 Substance Test T1015HF

Professional

Both

$10.59

Service Code	CPT T1015 HF
Hospital Charge Code	175T1015
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	$10.09
Rate for Payer: Sunshine Health Medicaid	$8.07

SA Treatment Plan - New and Established Patient

Professional

Both

$97.86

Service Code	CPT T1007
Hospital Charge Code	140T1007
Min. Negotiated Rate	$78.29
Max. Negotiated Rate	$102.75
Rate for Payer: Aetna Better Health CHIP/Medicaid	$102.75
Rate for Payer: Carelon Medicaid	$97.00
Rate for Payer: Magellan Medicaid	$97.86
Rate for Payer: Molina Complete Care CHIP/Medicaid	$97.86
Rate for Payer: Molina Complete Care Marketplace	$97.86
Rate for Payer: Sunshine Health FHK	$97.86
Rate for Payer: Sunshine Health Medicaid	$78.29
Rate for Payer: Sunshine Health Medicaid	$97.86

SA Treatment Plan Review T1007TS

Professional

Both

$51.38

Service Code	CPT T1007 TS
Hospital Charge Code	142T1007
Min. Negotiated Rate	$39.14
Max. Negotiated Rate	$51.38
Rate for Payer: Aetna Better Health CHIP/Medicaid	$51.38
Rate for Payer: Carelon Medicaid	$48.50
Rate for Payer: Magellan Medicaid	$48.93
Rate for Payer: Molina Complete Care CHIP/Medicaid	$48.93
Rate for Payer: Sunshine Health FHK	$48.93
Rate for Payer: Sunshine Health Medicaid	$48.93
Rate for Payer: Sunshine Health Medicaid	$39.14

SA Treatment Plan Review T1007TS

Professional

Both

$48.93

Service Code	CPT T1007
Hospital Charge Code	141T1007
Min. Negotiated Rate	$78.29
Max. Negotiated Rate	$102.75
Rate for Payer: Aetna Better Health CHIP/Medicaid	$102.75
Rate for Payer: Carelon Medicaid	$97.00
Rate for Payer: Magellan Medicaid	$97.86
Rate for Payer: Molina Complete Care CHIP/Medicaid	$97.86
Rate for Payer: Molina Complete Care Marketplace	$97.86
Rate for Payer: Sunshine Health FHK	$97.86
Rate for Payer: Sunshine Health Medicaid	$97.86
Rate for Payer: Sunshine Health Medicaid	$78.29

SA Vivitrol Admin. Est Clnt-CONTRACT-99212

Professional

Both

$1,421.00

Service Code	CPT 99212
Hospital Charge Code	5999212
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	$60.09
Rate for Payer: Humana Medicare	$55.80
Rate for Payer: Lucet Commercial	$29.52
Rate for Payer: Lucet Commercial	$26.05
Rate for Payer: Lucet Commercial	$31.26
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	$26.48
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$28.24
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$24.71

SA Vivitrol Assmnt Nw Clnt -CONTRACT-99205

Professional

Both

$540.00

Service Code	CPT 99205
Hospital Charge Code	4499205
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	$282.77
Rate for Payer: Humana Medicare	$262.57
Rate for Payer: Lucet Commercial	$160.90
Rate for Payer: Lucet Commercial	$134.08
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	$133.17
Rate for Payer: Sunshine Health Medicaid	$166.46
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 Vivitrol Screening - CONTRACT - 99408

Professional

Both

$150.00

Service Code	CPT 99408
Hospital Charge Code	6999408
Min. Negotiated Rate	$21.99
Max. Negotiated Rate	$52.82
Rate for Payer: Humana Commercial	$40.89
Rate for Payer: Humana Commercial	$47.70
Rate for Payer: Humana Commercial	$44.30
Rate for Payer: Prime Health Services Workers Comp	$52.82
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$23.56
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$21.99
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$25.13

STI counseling prevention/change (G0445)

Professional

Both

$83.00

Service Code	CPT G0445
Hospital Charge Code	71G0445
Min. Negotiated Rate	$15.67
Max. Negotiated Rate	$42.76
Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility	$22.02
Rate for Payer: Behavioral Services Network Medicare	$22.02
Rate for Payer: Carelon Medicare	$22.02
Rate for Payer: Lucet Commercial	$16.52
Rate for Payer: Lucet Commercial	$18.72
Rate for Payer: Lucet Commercial	$19.82
Rate for Payer: Molina Complete Care Medicare	$22.02
Rate for Payer: Prime Health Services Workers Comp	$42.76
Rate for Payer: Sunshine Health MMP/Medicare	$22.02
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$15.67
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$17.91
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$16.79

Targeted Case Management Adult T1017

Professional

Both

$36.00

Service Code	CPT T1017
Hospital Charge Code	180T1017
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Carelon Medicaid	$12.00

Targeted Case Management Child T1017HA

Professional

Both

$12.07

Service Code	CPT T1017
Hospital Charge Code	181T1017
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Carelon Medicaid	$12.00

Targeted Case Management Child T1017HA

Professional

Both

$36.00

Service Code	CPT T1017 HA
Hospital Charge Code	182T1017
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Carelon Medicaid	$12.00

TBOS - Therapeutic Behavioral On-Site Svcs Therapy

Professional

Both

$48.00

Service Code	CPT H2019 HO
Hospital Charge Code	134H2019
Min. Negotiated Rate	$15.27
Max. Negotiated Rate	$20.04
Rate for Payer: Aetna Better Health CHIP/Medicaid	$20.04
Rate for Payer: Carelon Medicaid	$16.00
Rate for Payer: Magellan Medicaid	$19.09
Rate for Payer: Molina Complete Care CHIP/Medicaid	$19.09
Rate for Payer: Sunshine Health FHK	$19.09
Rate for Payer: Sunshine Health Medicaid	$15.27
Rate for Payer: Sunshine Health Medicaid	$19.09

TBOS - Therapeutic Behavioral On-Site Svcs Therapy

Professional

Both

$19.09

Service Code	CPT H2019
Hospital Charge Code	133H2019
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	$36.23
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$33.82

Tenancy Sustaining Services- 591

Professional

Both

$15.00

Service Code	CPT H2015
Hospital Charge Code	121H2015
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Molina Complete Care Marketplace	$15.00

Tenancy Sustaining Services- 591

Professional

Both

$15.00

Service Code	CPT H2015 HK
Hospital Charge Code	122H2015
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Carelon Medicaid	$15.00

Therapy for Crisis-add'l 30 mins(90840)

Professional

Both

$90.00

Service Code	CPT 90840
Hospital Charge Code	2690840
Min. Negotiated Rate	$45.67
Max. Negotiated Rate	$126.22
Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility	$64.18
Rate for Payer: Behavioral Services Network Medicare	$64.18
Rate for Payer: Carelon Medicare	$64.18
Rate for Payer: Humana Commercial	$126.22
Rate for Payer: Humana Commercial	$117.21
Rate for Payer: Humana Commercial	$108.19
Rate for Payer: Lucet Commercial	$57.76
Rate for Payer: Lucet Commercial	$48.14
Rate for Payer: Lucet Commercial	$54.55
Rate for Payer: Molina Complete Care Medicare	$64.18
Rate for Payer: Prime Health Services Workers Comp	$113.31
Rate for Payer: Sunshine Health MMP/Medicare	$64.18
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$52.19
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$45.67
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$48.93

Therapy for Crisis-first 60 mins (90839)

Professional

Both

$180.00

Service Code	CPT 90839
Hospital Charge Code	2590839
Min. Negotiated Rate	$90.58
Max. Negotiated Rate	$252.46
Rate for Payer: Aetna Better Health Medicare-Medicaid Dual Eligibility	$127.29
Rate for Payer: Behavioral Services Network Medicare	$127.29
Rate for Payer: Carelon Medicare	$127.29
Rate for Payer: Humana Commercial	$252.46
Rate for Payer: Humana Commercial	$234.43
Rate for Payer: Humana Commercial	$216.40
Rate for Payer: Lucet Commercial	$114.56
Rate for Payer: Lucet Commercial	$108.20
Rate for Payer: Lucet Commercial	$95.47
Rate for Payer: Molina Complete Care Medicare	$127.29
Rate for Payer: Prime Health Services Workers Comp	$227.36
Rate for Payer: Sunshine Health MMP/Medicare	$127.29
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$97.05
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$90.58
Rate for Payer: Tricare Military (Humana Behavioral Health) CHAMPVA/Tricare	$103.52

Transitional Housing Services-593

Professional

Both

$40.00

Service Code	CPT H0043 HK
Hospital Charge Code	102H0043
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$105.00
Rate for Payer: Carelon Medicaid	$40.00
Rate for Payer: Molina Complete Care Marketplace	$105.00

Know your out-of-pocket cost for care.

All Charges