Common use of Eligibility Category Clause in Contracts

Eligibility Category. Children and Family Month 0-2 All $ 75% $ $ 25% $ $ $ Month 3-11 All $ 75% $ $ 25% $ $ $ 1-5 All $ 75% $ $ 25% $ $ $ 6-13 All $ 75% $ $ 25% $ $ $ 14-20 Female $ 75% $ $ 25% $ $ $ 14-20 Male $ 75% $ $ 25% $ $ $ 21-54 Female $ 75% $ $ 25% $ $ $ 21-54 Male $ 75% $ $ 25% $ $ $ 55+ All $ 75% $ $ 25% $ $ $ Composite $ $ Eligibility Category: Aged and Disabled Month 0-2 All $ 75% $ $ 25% $ $ $ Month 3-11 All $ 75% $ $ 25% $ $ $ 1-5 All $ 75% $ $ 25% $ $ $ 6-13 All $ 75% $ $ 25% $ $ $ 14-20 All $ 75% $ $ 25% $ $ $ 21-54 All $ 75% $ $ 25% $ $ $ 55+ All $ 75% $ $ 25% $ $ $ Composite $ $ REMAINDER OF PAGE INTENTIONALLY LEFT BLANK HEALTHEASE OF FLORIDA EXHIBIT 5 CAPITATION RATES SSI MEDICARE PART B ONLY AND SSI MEDICARE PARTS A AND B ENROLLEES FOR ALL MEDICAID REFORM COUNTIES TABLE 4 Area: 4 County: Dxxxx ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Under Age 65 Age 65 & Over SSI/Parts A & B $146.72 $98.34 SSI/Part B Only $300.24 $300.24 Area: 10 County: Broward ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Under Age 65 Age 65 & Over SSI/Parts A & B $136.17 $91.25 SSI/Part B Only $210.84 $210.84 REMAINDER OF PAGE INTENTIONALLY LEFT BLANK HEALTHEASE OF FLORIDA EXHIBIT 6 CAPITATION RATES FOR HIV/AIDS POPULATIONS FOR EACH MEDICAID REFORM COUNTY TABLE 5 Area: 4 County: Dxxxx ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Capitation Rate HIV (No Medicare) $950.48 AIDS (No Medicare) $2133.29 HIV-SSI/Parts A & B, SSI Part B Only $177.88 AIDS-SSI/Parts A & B, SSI Part B Only $249.55 Area: 10 County: Broward ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Capitation Rate HIV (No Medicare) $1484.87 AIDS (No Medicare) $3155.16 HIV-SSI/Parts A & B, SSI Part B Only $213.18 AIDS-SSI/Parts A & B, SSI Part B Only $299.07 REMAINDER OF PAGE INTENTIONALLY LEFT BLANK HEALTHEASE OF FLORIDA EXHIBIT 7 CAPITATION RATES FOR MEDICAID REFORM COUNTIES FOR ALL MEDICAID REFORM COUNTIES TABLE 6 Area: __________________ County: ____________________ ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Age < 1 Yr Age 1 Yr Age 2 - 20 Yrs Children with Chronic Conditions $ $ $ REMAINDER OF PAGE INTENTIONALLY LEFT BLANK HEALTHEASE OF FLORIDA EXHIBIT 8 KICK PAYMENT AMOUNTS FOR COVERED TRANSPLANT SERVICES TABLE 7 Area: __10_______ County: ____Broward_______ Area: ___04______ County: _____Duval________ CPT Code Transplant CPT Code Description Children/Adolescents or Adult Payment Amount 32851 lung single, without bypass Children/Adolescents $320,800.00 32851 lung single, without bypass Adult $238,000.00 32852 lung single, with bypass Children/Adolescents $320,800.00 32852 lung single, with bypass Adult $238,000.00 32853 lung double, without bypass Children/Adolescents $320,800.00 32853 lung double, without bypass Adult $238,000.00 32854 lung double, with bypass Children/Adolescents $320,800.00 32854 lung double, with bypass Adult $238,000.00 33945 heart transplant with or without recipient cardiectomy Children/Adolescents $162,000.00 33945 heart transplant with or without recipient cardiectomy Adult $162,000.00 47135 liver, allotransplation, orthotopic, partial or whole from cadaver or living donor Children/Adolescents $122,600.00 47135 liver, allotransplation, orthotopic, partial or whole from cadaver or living donor Adult $122,600.00 47136 liver, heterotopic, partial or whole from cadaver or living donor any age Children/Adolescents $122,600.00 47136 liver, heterotopic, partial or whole from cadaver or living donor any age Adult $122,600.00 REMAINDER OF PAGE INTENTIONALLY LEFT BLANK HEALTHEASE OF FLORIDA EXHIBIT 9 KICK PAYMENT AMOUNTS FOR COVERED OBSTETRICAL DELIVERY SERVICES TABLE 8 Area: ____10_______ County: _____Broward_______ CPT Code Obstetrical Delivery CPT Code Description Payment Amount 59409 Vaginal delivery only $4,143.00 59410 Vaginal delivery including postpartum care 59515 Cesarean delivery including postpartum care 59612 Vaginal delivery only, after previous cesarean delivery 59614 Vaginal delivery only, after previous cesarean delivery including postpartum care 59622 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery including postpartum care Area: ______04_________ County: _____Duval________ CPT Code Obstetrical Delivery CPT Code Description Payment Amount 59409 Vaginal delivery only $4,097.62 59410 Vaginal delivery including postpartum care 59515 Cesarean delivery including postpartum care 59612 Vaginal delivery only, after previous cesarean delivery 59614 Vaginal delivery only, after previous cesarean delivery including postpartum care 59622 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery including postpartum care ATTACHMENT II Medicaid Reform Health Plan Model Contract July 2006 Table of Contents Section I Definitions and Acronyms A. Definitions

Eligibility Category. Children and Family Month 0-2 All $ 75% $ $ 25% $ $ $ Month 3-11 All $ 75% $ $ 25% $ $ $ 1-5 All $ 75% $ $ 25% $ $ $ 6-13 All $ 75% $ $ 25% $ $ $ 14-20 Female $ 75% $ $ 25% $ $ $ 14-20 Male $ 75% $ $ 25% $ $ $ 21-54 Female $ 75% $ $ 25% $ $ $ 21-54 Male $ 75% $ $ 25% $ $ $ 55+ All $ 75% $ $ 25% $ $ $ Composite $ $ Eligibility Category: Aged and Disabled Month 0-2 All $ 75% $ $ 25% $ $ $ Month 3-11 All $ 75% $ $ 25% $ $ $ 1-5 All $ 75% $ $ 25% $ $ $ 6-13 All $ 75% $ $ 25% $ $ $ 14-20 All $ 75% $ $ 25% $ $ $ 21-54 All $ 75% $ $ 25% $ $ $ 55+ All $ 75% $ $ 25% $ $ $ Composite $ $ REMAINDER OF PAGE INTENTIONALLY LEFT BLANK HEALTHEASE OF FLORIDA EXHIBIT 5 CAPITATION RATES SSI MEDICARE PART B ONLY AND SSI MEDICARE PARTS A AND B ENROLLEES FOR ALL MEDICAID REFORM COUNTIES TABLE 4 Area: 4 County: Dxxxx Xxxxx ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Under Age 65 Age 65 & Over SSI/Parts A & B $146.72 $98.34 SSI/Part B Only $300.24 $300.24 Area: 10 County: Broward ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Under Age 65 Age 65 & Over SSI/Parts A & B $136.17 $91.25 SSI/Part B Only $210.84 $210.84 REMAINDER OF PAGE INTENTIONALLY LEFT BLANK HEALTHEASE OF FLORIDA EXHIBIT 6 CAPITATION RATES FOR HIV/AIDS POPULATIONS FOR EACH MEDICAID REFORM COUNTY TABLE 5 Area: 4 County: Dxxxx Xxxxx ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Capitation Rate HIV (No Medicare) $950.48 AIDS (No Medicare) $2133.29 HIV-SSI/Parts A & B, SSI Part B Only $177.88 AIDS-SSI/Parts A & B, SSI Part B Only $249.55 Area: 10 County: Broward ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Capitation Rate HIV (No Medicare) $1484.87 AIDS (No Medicare) $3155.16 HIV-SSI/Parts A & B, SSI Part B Only $213.18 AIDS-SSI/Parts A & B, SSI Part B Only $299.07 REMAINDER OF PAGE INTENTIONALLY LEFT BLANK HEALTHEASE OF FLORIDA EXHIBIT 7 CAPITATION RATES FOR MEDICAID REFORM COUNTIES FOR ALL MEDICAID REFORM COUNTIES TABLE 6 Area: _____________ County: ______ County: ____________________ ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Age < 1 Yr Age 1 Yr Age 2 - 20 Yrs Children with Chronic Conditions $ $ $ REMAINDER OF PAGE INTENTIONALLY LEFT BLANK HEALTHEASE OF FLORIDA EXHIBIT 8 KICK PAYMENT AMOUNTS FOR COVERED TRANSPLANT SERVICES TABLE 7 Areas: 10 County: Broward Area: __10_______ 4 County: ____Broward_______ Area: ___04______ County: _____Duval________ Xxxxx CPT Code Transplant CPT Code Description Children/Adolescents or Adult Payment Amount 32851 lung single, without bypass Children/Adolescents $320,800.00 32851 lung single, without bypass Adult $238,000.00 32852 lung single, with bypass Children/Adolescents $320,800.00 32852 lung single, with bypass Adult $238,000.00 32853 lung double, without bypass Children/Adolescents $320,800.00 32853 lung double, without bypass Adult $238,000.00 32854 lung double, with bypass Children/Adolescents $320,800.00 32854 lung double, with bypass Adult $238,000.00 33945 heart transplant with or without recipient cardiectomy Children/Adolescents $162,000.00 33945 heart transplant with or without recipient cardiectomy Adult $162,000.00 47135 liver, allotransplation, orthotopic, partial or whole from cadaver or living donor Children/Adolescents $122,600.00 47135 liver, allotransplation, orthotopic, partial or whole from cadaver or living donor Adult $122,600.00 47136 liver, heterotopic, partial or whole from cadaver or living donor any age Children/Adolescents $122,600.00 47136 liver, heterotopic, partial or whole from cadaver or living donor any age Adult $122,600.00 REMAINDER OF PAGE INTENTIONALLY LEFT BLANK HEALTHEASE OF FLORIDA EXHIBIT 9 KICK PAYMENT AMOUNTS FOR COVERED OBSTETRICAL DELIVERY SERVICES TABLE 8 Area: ____10_______ 10 County: _____Broward_______ Broward CPT Code Obstetrical Delivery CPT Code Description Payment Amount 59409 Vaginal delivery only $4,143.00 59410 Vaginal delivery including postpartum care 59515 Cesarean delivery including postpartum care 59612 Vaginal delivery only, after previous cesarean delivery 59614 Vaginal delivery only, after previous cesarean delivery including postpartum care 59622 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery including postpartum care Area: ______04_________ 04 County: _____Duval________ Xxxxx CPT Code Obstetrical Delivery CPT Code Description Payment Amount 59409 Vaginal delivery only $4,097.62 59410 Vaginal delivery including postpartum care 59515 Cesarean delivery including postpartum care 59612 Vaginal delivery only, after previous cesarean delivery 59614 Vaginal delivery only, after previous cesarean delivery including postpartum care 59622 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery including postpartum care REMAINDER OF PAGE INTENTIONALLY LEFT BLANK ATTACHMENT II Medicaid Reform Health Plan Model Contract July 2006 Table of Contents Section I Definitions and Acronyms A. Definitions

Eligibility Category. Children and Family Month 0-2 All $ 75% $ $ 25% $ $ $ Month 3-11 All $ 75% $ $ 25% $ $ $ 1-5 All $ 75% $ $ 25% $ $ $ 6-13 All $ 75% $ $ 25% $ $ $ 14-20 Female $ 75% $ $ 25% $ $ $ 14-20 Male $ 75% $ $ 25% $ $ $ 21-54 Female $ 75% $ $ 25% $ $ $ 21-54 Male $ 75% $ $ 25% $ $ $ 55+ All $ 75% $ $ 25% $ $ $ Composite $ $ Eligibility Category: Aged and Disabled Month 0-2 All $ 75% $ $ 25% $ $ $ Month 3-11 All $ 75% $ $ 25% $ $ $ 1-5 All $ 75% $ $ 25% $ $ $ 6-13 All $ 75% $ $ 25% $ $ $ 14-20 All $ 75% $ $ 25% $ $ $ 21-54 All $ 75% $ $ 25% $ $ $ 55+ All $ 75% $ $ 25% $ $ $ Composite $ $ REMAINDER OF PAGE INTENTIONALLY LEFT BLANK HEALTHEASE OF FLORIDA AHCA Contract No. FAR009, Exhibit 4-A, Page 1 of 1 EXHIBIT 5 5-A CAPITATION RATES SSI MEDICARE PART B ONLY AND SSI MEDICARE PARTS A AND B ENROLLEES FOR ALL MEDICAID REFORM COUNTIES TABLE 4 Area: 4 County: Dxxxx Duval, Baker, Clay and Nassau ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Under Age 65 Age 65 & Over SSI/Parts A & B $146.72 200.51 $98.34 135.15 SSI/Part B Only $300.24 369.64 $300.24 369.64 Area: 10 County: Broward ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Under Age 65 Age 65 & Over SSI/Parts A & B $136.17 192.29 $91.25 129.85 SSI/Part B Only $210.84 249.37 $210.84 249.37 REMAINDER OF PAGE INTENTIONALLY LEFT BLANK HEALTHEASE OF FLORIDA AHCA Contract No. FAR009, Exhibit 5-A, Page 1 of 1 EXHIBIT 6 6-A CAPITATION RATES FOR HIV/AIDS POPULATIONS FOR EACH MEDICAID REFORM COUNTY TABLE 5 Area: 4 County: Dxxxx Duval, Baker, Clay and Nassau ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Capitation Rate HIV (No Medicareno medicare) $950.48 1,216.29 AIDS (No Medicareno medicare) $2133.29 2,394.42 HIV-SSI/Parts A & B, SSI Part B Only $177.88 $ 294.90 AIDS-SSI/Parts A & B, SSI Part B Only $249.55 $ 291.91 Area: 10 County: Broward ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Capitation Rate HIV (No Medicareno medicare) $1484.87 1,966.44 AIDS (No Medicareno medicare) $3155.16 3,690.27 HIV-SSI/Parts A & B, SSI Part B Only $213.18 $ 331.60 AIDS-SSI/Parts A & B, SSI Part B Only $299.07 $ 708.10 REMAINDER OF PAGE INTENTIONALLY LEFT BLANK HEALTHEASE OF FLORIDA AHCA Contract No. FAR009, Exhibit 6-A, Page 1 of 1 EXHIBIT 7 7-A CAPITATION RATES FOR MEDICAID REFORM COUNTIES CHILDREN WITH CHRONIC CONDITIONS FOR ALL MEDICAID REFORM COUNTIES TABLE 6 Area: _____:_____________ County: _____________________ ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Age < 1 Yr Age 1 Yr Age 2 - 20 Yrs Children with Chronic Conditions $ $ $ REMAINDER OF PAGE INTENTIONALLY LEFT BLANK HEALTHEASE OF FLORIDA AHCA Contract No. FAR009, Exhibit 7-A, Page 1 of 1 EXHIBIT 8 8-A KICK PAYMENT AMOUNTS FOR COVERED TRANSPLANT SERVICES TABLE 7 Area: __10_______ 4 County: ____Broward_______ Area: ___04______ County: _____Duval________ CPT Code Transplant CPT Code Description Children/Adolescents or Adult Payment Amount 32851 lung single, without bypass Children/Adolescents $320,800.00 32851 lung singleBaker, without bypass Adult $238,000.00 32852 lung single, with bypass Children/Adolescents $320,800.00 32852 lung single, with bypass Adult $238,000.00 32853 lung double, without bypass Children/Adolescents $320,800.00 32853 lung double, without bypass Adult $238,000.00 32854 lung double, with bypass Children/Adolescents $320,800.00 32854 lung double, with bypass Adult $238,000.00 33945 heart transplant with or without recipient cardiectomy Children/Adolescents $162,000.00 33945 heart transplant with or without recipient cardiectomy Adult $162,000.00 47135 liver, allotransplation, orthotopic, partial or whole from cadaver or living donor Children/Adolescents $122,600.00 47135 liver, allotransplation, orthotopic, partial or whole from cadaver or living donor Adult $122,600.00 47136 liver, heterotopic, partial or whole from cadaver or living donor any age Children/Adolescents $122,600.00 47136 liver, heterotopic, partial or whole from cadaver or living donor any age Adult $122,600.00 REMAINDER OF PAGE INTENTIONALLY LEFT BLANK HEALTHEASE OF FLORIDA EXHIBIT 9 KICK PAYMENT AMOUNTS FOR COVERED OBSTETRICAL DELIVERY SERVICES TABLE 8 Area: ____10_______ County: _____Broward_______ CPT Code Obstetrical Delivery CPT Code Description Payment Amount 59409 Vaginal delivery only $4,143.00 59410 Vaginal delivery including postpartum care 59515 Cesarean delivery including postpartum care 59612 Vaginal delivery only, after previous cesarean delivery 59614 Vaginal delivery only, after previous cesarean delivery including postpartum care 59622 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery including postpartum care Area: ______04_________ County: _____Duval________ CPT Code Obstetrical Delivery CPT Code Description Payment Amount 59409 Vaginal delivery only $4,097.62 59410 Vaginal delivery including postpartum care 59515 Cesarean delivery including postpartum care 59612 Vaginal delivery only, after previous cesarean delivery 59614 Vaginal delivery only, after previous cesarean delivery including postpartum care 59622 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery including postpartum care ATTACHMENT II Medicaid Reform Health Plan Model Contract July 2006 Table of Contents Section I Definitions Clay and Acronyms A. DefinitionsNassau

Eligibility Category. Children and Family Month 0-2 All $ 7575 % $ $ 2525 % $ $ $ Month 3-11 All $ 7575 % $ $ 2525 % $ $ $ 1-5 All $ 7575 % $ $ 2525 % $ $ $ 6-13 All $ 7575 % $ $ 2525 % $ $ $ 14-20 Female $ 7575 % $ $ 2525 % $ $ $ 14-20 Male $ 7575 % $ $ 2525 % $ $ $ 21-54 Female $ 7575 % $ $ 2525 % $ $ $ 21-54 Male $ 7575 % $ $ 2525 % $ $ $ 55+ All $ 7575 % $ $ 2525 % $ $ $ Composite $ $ Eligibility Category: Aged and Disabled Month 0-2 All $ 7575 % $ $ 2525 % $ $ $ Month 3-11 All $ 7575 % $ $ 2525 % $ $ $ 1-5 All $ 7575 % $ $ 2525 % $ $ $ 6-13 All $ 7575 % $ $ 2525 % $ $ $ 14-20 All $ 7575 % $ $ 2525 % $ $ $ 21-54 All $ 7575 % $ $ 2525 % $ $ $ 55+ All $ 7575 % $ $ 2525 % $ $ $ Composite $ $ REMAINDER OF PAGE INTENTIONALLY LEFT BLANK HEALTHEASE OF FLORIDA AHCA Contract No. FAR001, Exhibit 4-A, Page 1 of 1 EXHIBIT 5 5-A CAPITATION RATES SSI MEDICARE PART B ONLY AND SSI MEDICARE PARTS A AND B ENROLLEES FOR ALL MEDICAID REFORM COUNTIES TABLE 4 Area: 4 County: Dxxxx Duval, Baker, Clay and Nassau ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Under Age 65 Age 65 & Over SSI/Parts A & B $146.72 200.51 $98.34 135.15 SSI/Part B Only $300.24 369.64 $300.24 369.64 Area: 10 County: Broward ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Under Age 65 Age 65 & Over SSI/Parts A & B $136.17 192.29 $91.25 129.85 SSI/Part B Only $210.84 249.37 $210.84 249.37 REMAINDER OF PAGE INTENTIONALLY LEFT BLANK HEALTHEASE OF FLORIDA AHCA Contract No. FAR001, Exhibit 5-A, Page 1 of 1 EXHIBIT 6 6-A CAPITATION RATES FOR HIV/AIDS POPULATIONS FOR EACH MEDICAID REFORM COUNTY TABLE 5 Area: 4 County: Dxxxx Duval, Baker, Clay and Nassau ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Capitation Rate HIV (No Medicareno medicare) $950.48 1,216.29 AIDS (No Medicareno medicare) $2133.29 2,394.42 HIV-SSI/Parts A & B, SSI Part B Only $177.88 $ 294.90 AIDS-SSI/Parts A & B, SSI Part B Only $249.55 $ 291.91 Area: 10 County: Broward ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Capitation Rate HIV (No Medicareno medicare) $1484.87 1,966.44 AIDS (No Medicareno medicare) $3155.16 3,690.27 HIV-SSI/Parts A & B, SSI Part B Only $213.18 $ 331.60 AIDS-SSI/Parts A & B, SSI Part B Only $299.07 $ 708.10 REMAINDER OF PAGE INTENTIONALLY LEFT BLANK HEALTHEASE OF FLORIDA EXHIBIT 7 7-A CAPITATION RATES FOR MEDICAID REFORM COUNTIES CHILDREN WITH CHRONIC CONDITIONS FOR ALL MEDICAID REFORM COUNTIES TABLE 6 Area: __________________ County: ____________________ ESTIMATED HEALTH PLAN RATES (NOT FOR USE UNLESS APPROVED BY CMS) Age < 1 Yr Age 1 Yr Age 2 - 20 Yrs Children with Chronic Conditions $ $ $ REMAINDER OF PAGE INTENTIONALLY LEFT BLANK HEALTHEASE OF FLORIDA AHCA Contract No. FAR001, Exhibit 7-A, Page 1 of 1 EXHIBIT 8 8-A KICK PAYMENT AMOUNTS FOR COVERED TRANSPLANT SERVICES TABLE 7 Area: __10_______ 4 County: ____Broward_______ Area: ___04______ County: _____Duval________ CPT Code Transplant CPT Code Description Children/Adolescents or Adult Payment Amount 32851 lung single, without bypass Children/Adolescents $320,800.00 32851 lung singleBaker, without bypass Adult $238,000.00 32852 lung single, with bypass Children/Adolescents $320,800.00 32852 lung single, with bypass Adult $238,000.00 32853 lung double, without bypass Children/Adolescents $320,800.00 32853 lung double, without bypass Adult $238,000.00 32854 lung double, with bypass Children/Adolescents $320,800.00 32854 lung double, with bypass Adult $238,000.00 33945 heart transplant with or without recipient cardiectomy Children/Adolescents $162,000.00 33945 heart transplant with or without recipient cardiectomy Adult $162,000.00 47135 liver, allotransplation, orthotopic, partial or whole from cadaver or living donor Children/Adolescents $122,600.00 47135 liver, allotransplation, orthotopic, partial or whole from cadaver or living donor Adult $122,600.00 47136 liver, heterotopic, partial or whole from cadaver or living donor any age Children/Adolescents $122,600.00 47136 liver, heterotopic, partial or whole from cadaver or living donor any age Adult $122,600.00 REMAINDER OF PAGE INTENTIONALLY LEFT BLANK HEALTHEASE OF FLORIDA EXHIBIT 9 KICK PAYMENT AMOUNTS FOR COVERED OBSTETRICAL DELIVERY SERVICES TABLE 8 Area: ____10_______ County: _____Broward_______ CPT Code Obstetrical Delivery CPT Code Description Payment Amount 59409 Vaginal delivery only $4,143.00 59410 Vaginal delivery including postpartum care 59515 Cesarean delivery including postpartum care 59612 Vaginal delivery only, after previous cesarean delivery 59614 Vaginal delivery only, after previous cesarean delivery including postpartum care 59622 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery including postpartum care Area: ______04_________ County: _____Duval________ CPT Code Obstetrical Delivery CPT Code Description Payment Amount 59409 Vaginal delivery only $4,097.62 59410 Vaginal delivery including postpartum care 59515 Cesarean delivery including postpartum care 59612 Vaginal delivery only, after previous cesarean delivery 59614 Vaginal delivery only, after previous cesarean delivery including postpartum care 59622 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery including postpartum care ATTACHMENT II Medicaid Reform Health Plan Model Contract July 2006 Table of Contents Section I Definitions Clay and Acronyms A. DefinitionsNassau