|
INVEGA SSTENNA 1MG (234MG)
|
Facility
|
OP
|
$69.52
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$66.74 |
| Rate for Payer: Aetna Commercial |
$53.53
|
| Rate for Payer: Anthem Medicaid |
$23.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.33
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cigna Commercial |
$57.70
|
| Rate for Payer: First Health Commercial |
$66.04
|
| Rate for Payer: Humana Commercial |
$59.09
|
| Rate for Payer: Humana KY Medicaid |
$23.91
|
| Rate for Payer: Humana Medicare Advantage |
$14.32
|
| Rate for Payer: Kentucky WC Medicaid |
$24.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.18
|
| Rate for Payer: Ohio Health Group HMO |
$52.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.55
|
| Rate for Payer: PHCS Commercial |
$66.74
|
| Rate for Payer: United Healthcare All Payer |
$61.18
|
|
|
INVEGA SSTENNA 1MG (234MG)
|
Facility
|
OP
|
$69.52
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
636T0048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$66.74 |
| Rate for Payer: Aetna Commercial |
$53.53
|
| Rate for Payer: Anthem Medicaid |
$23.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.33
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cigna Commercial |
$57.70
|
| Rate for Payer: First Health Commercial |
$66.04
|
| Rate for Payer: Humana Commercial |
$59.09
|
| Rate for Payer: Humana KY Medicaid |
$23.91
|
| Rate for Payer: Humana Medicare Advantage |
$14.32
|
| Rate for Payer: Kentucky WC Medicaid |
$24.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.18
|
| Rate for Payer: Ohio Health Group HMO |
$52.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.55
|
| Rate for Payer: PHCS Commercial |
$66.74
|
| Rate for Payer: United Healthcare All Payer |
$61.18
|
|
|
INVEGA SUSTENNA 1MG (117MG)
|
Facility
|
IP
|
$9,479.35
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
25002291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,232.32 |
| Max. Negotiated Rate |
$9,100.18 |
| Rate for Payer: Aetna Commercial |
$7,299.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.89
|
| Rate for Payer: Cash Price |
$4,739.68
|
| Rate for Payer: Cigna Commercial |
$7,867.86
|
| Rate for Payer: First Health Commercial |
$9,005.38
|
| Rate for Payer: Humana Commercial |
$8,057.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,773.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.83
|
| Rate for Payer: Ohio Health Group HMO |
$7,109.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.60
|
| Rate for Payer: PHCS Commercial |
$9,100.18
|
| Rate for Payer: United Healthcare All Payer |
$8,341.83
|
|
|
INVEGA SUSTENNA 1MG (117MG)
|
Facility
|
OP
|
$9,479.35
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
25002291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$9,100.18 |
| Rate for Payer: Aetna Commercial |
$7,299.10
|
| Rate for Payer: Anthem Medicaid |
$3,259.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.33
|
| Rate for Payer: Cash Price |
$4,739.68
|
| Rate for Payer: Cash Price |
$4,739.68
|
| Rate for Payer: Cigna Commercial |
$7,867.86
|
| Rate for Payer: First Health Commercial |
$9,005.38
|
| Rate for Payer: Humana Commercial |
$8,057.45
|
| Rate for Payer: Humana KY Medicaid |
$3,259.95
|
| Rate for Payer: Humana Medicare Advantage |
$14.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,293.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,773.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,325.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.83
|
| Rate for Payer: Ohio Health Group HMO |
$7,109.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.60
|
| Rate for Payer: PHCS Commercial |
$9,100.18
|
| Rate for Payer: United Healthcare All Payer |
$8,341.83
|
|
|
INVEGA SUSTENNA 1MG (117MG)
|
Facility
|
IP
|
$69.52
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
636T0050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$66.74 |
| Rate for Payer: Aetna Commercial |
$53.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.23
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cigna Commercial |
$57.70
|
| Rate for Payer: First Health Commercial |
$66.04
|
| Rate for Payer: Humana Commercial |
$59.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.18
|
| Rate for Payer: Ohio Health Group HMO |
$52.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.55
|
| Rate for Payer: PHCS Commercial |
$66.74
|
| Rate for Payer: United Healthcare All Payer |
$61.18
|
|
|
INVEGA SUSTENNA 1MG (117MG)
|
Facility
|
OP
|
$69.52
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$66.74 |
| Rate for Payer: Aetna Commercial |
$53.53
|
| Rate for Payer: Anthem Medicaid |
$23.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.33
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cigna Commercial |
$57.70
|
| Rate for Payer: First Health Commercial |
$66.04
|
| Rate for Payer: Humana Commercial |
$59.09
|
| Rate for Payer: Humana KY Medicaid |
$23.91
|
| Rate for Payer: Humana Medicare Advantage |
$14.32
|
| Rate for Payer: Kentucky WC Medicaid |
$24.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.18
|
| Rate for Payer: Ohio Health Group HMO |
$52.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.55
|
| Rate for Payer: PHCS Commercial |
$66.74
|
| Rate for Payer: United Healthcare All Payer |
$61.18
|
|
|
INVEGA SUSTENNA 1MG (117MG)
|
Professional
|
Both
|
$69.52
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$69.52 |
| Rate for Payer: Aetna Commercial |
$17.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$69.52
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.16
|
| Rate for Payer: Multiplan PHCS |
$41.71
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.66
|
| Rate for Payer: UHCCP Medicaid |
$24.33
|
|
|
INVEGA SUSTENNA 1MG (117MG)
|
Facility
|
OP
|
$69.52
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
636T0050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$66.74 |
| Rate for Payer: Aetna Commercial |
$53.53
|
| Rate for Payer: Anthem Medicaid |
$23.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.33
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cigna Commercial |
$57.70
|
| Rate for Payer: First Health Commercial |
$66.04
|
| Rate for Payer: Humana Commercial |
$59.09
|
| Rate for Payer: Humana KY Medicaid |
$23.91
|
| Rate for Payer: Humana Medicare Advantage |
$14.32
|
| Rate for Payer: Kentucky WC Medicaid |
$24.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.18
|
| Rate for Payer: Ohio Health Group HMO |
$52.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.55
|
| Rate for Payer: PHCS Commercial |
$66.74
|
| Rate for Payer: United Healthcare All Payer |
$61.18
|
|
|
INVEGA SUSTENNA 1MG (117MG)
|
Facility
|
IP
|
$69.52
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$66.74 |
| Rate for Payer: Aetna Commercial |
$53.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.23
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cigna Commercial |
$57.70
|
| Rate for Payer: First Health Commercial |
$66.04
|
| Rate for Payer: Humana Commercial |
$59.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.18
|
| Rate for Payer: Ohio Health Group HMO |
$52.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.55
|
| Rate for Payer: PHCS Commercial |
$66.74
|
| Rate for Payer: United Healthcare All Payer |
$61.18
|
|
|
INVEGA SUSTENNA 1MG (156MG)
|
Facility
|
OP
|
$12,639.59
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
25002288
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$12,134.01 |
| Rate for Payer: Aetna Commercial |
$9,732.48
|
| Rate for Payer: Anthem Medicaid |
$4,346.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,858.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.33
|
| Rate for Payer: Cash Price |
$6,319.80
|
| Rate for Payer: Cash Price |
$6,319.80
|
| Rate for Payer: Cigna Commercial |
$10,490.86
|
| Rate for Payer: First Health Commercial |
$12,007.61
|
| Rate for Payer: Humana Commercial |
$10,743.65
|
| Rate for Payer: Humana KY Medicaid |
$4,346.76
|
| Rate for Payer: Humana Medicare Advantage |
$14.32
|
| Rate for Payer: Kentucky WC Medicaid |
$4,390.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,364.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,328.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,433.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,122.84
|
| Rate for Payer: Ohio Health Group HMO |
$9,479.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,527.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,643.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,918.27
|
| Rate for Payer: PHCS Commercial |
$12,134.01
|
| Rate for Payer: United Healthcare All Payer |
$11,122.84
|
|
|
INVEGA SUSTENNA 1MG (156MG)
|
Facility
|
OP
|
$69.53
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Aetna Commercial |
$53.54
|
| Rate for Payer: Anthem Medicaid |
$23.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.33
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cigna Commercial |
$57.71
|
| Rate for Payer: First Health Commercial |
$66.05
|
| Rate for Payer: Humana Commercial |
$59.10
|
| Rate for Payer: Humana KY Medicaid |
$23.91
|
| Rate for Payer: Humana Medicare Advantage |
$14.32
|
| Rate for Payer: Kentucky WC Medicaid |
$24.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.19
|
| Rate for Payer: Ohio Health Group HMO |
$52.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.55
|
| Rate for Payer: PHCS Commercial |
$66.75
|
| Rate for Payer: United Healthcare All Payer |
$61.19
|
|
|
INVEGA SUSTENNA 1MG (156MG)
|
Facility
|
OP
|
$69.53
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
636T0047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Aetna Commercial |
$53.54
|
| Rate for Payer: Anthem Medicaid |
$23.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.33
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cigna Commercial |
$57.71
|
| Rate for Payer: First Health Commercial |
$66.05
|
| Rate for Payer: Humana Commercial |
$59.10
|
| Rate for Payer: Humana KY Medicaid |
$23.91
|
| Rate for Payer: Humana Medicare Advantage |
$14.32
|
| Rate for Payer: Kentucky WC Medicaid |
$24.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.19
|
| Rate for Payer: Ohio Health Group HMO |
$52.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.55
|
| Rate for Payer: PHCS Commercial |
$66.75
|
| Rate for Payer: United Healthcare All Payer |
$61.19
|
|
|
INVEGA SUSTENNA 1MG (156MG)
|
Facility
|
IP
|
$69.53
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
636T0047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Aetna Commercial |
$53.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.23
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cigna Commercial |
$57.71
|
| Rate for Payer: First Health Commercial |
$66.05
|
| Rate for Payer: Humana Commercial |
$59.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.19
|
| Rate for Payer: Ohio Health Group HMO |
$52.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.55
|
| Rate for Payer: PHCS Commercial |
$66.75
|
| Rate for Payer: United Healthcare All Payer |
$61.19
|
|
|
INVEGA SUSTENNA 1MG (156MG)
|
Professional
|
Both
|
$69.53
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$69.53 |
| Rate for Payer: Aetna Commercial |
$17.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$69.53
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.16
|
| Rate for Payer: Multiplan PHCS |
$41.72
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.67
|
| Rate for Payer: UHCCP Medicaid |
$24.34
|
|
|
INVEGA SUSTENNA 1MG (156MG)
|
Facility
|
IP
|
$12,639.59
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
25002288
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,643.15 |
| Max. Negotiated Rate |
$12,134.01 |
| Rate for Payer: Aetna Commercial |
$9,732.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,858.88
|
| Rate for Payer: Cash Price |
$6,319.80
|
| Rate for Payer: Cigna Commercial |
$10,490.86
|
| Rate for Payer: First Health Commercial |
$12,007.61
|
| Rate for Payer: Humana Commercial |
$10,743.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,364.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,328.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,122.84
|
| Rate for Payer: Ohio Health Group HMO |
$9,479.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,527.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,643.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,918.27
|
| Rate for Payer: PHCS Commercial |
$12,134.01
|
| Rate for Payer: United Healthcare All Payer |
$11,122.84
|
|
|
INVEGA SUSTENNA 1MG (156MG)
|
Facility
|
IP
|
$69.53
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Aetna Commercial |
$53.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.23
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cigna Commercial |
$57.71
|
| Rate for Payer: First Health Commercial |
$66.05
|
| Rate for Payer: Humana Commercial |
$59.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.19
|
| Rate for Payer: Ohio Health Group HMO |
$52.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.55
|
| Rate for Payer: PHCS Commercial |
$66.75
|
| Rate for Payer: United Healthcare All Payer |
$61.19
|
|
|
INVEGA SUSTENNA 1MG (39MG)
|
Facility
|
OP
|
$69.52
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
636T0049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$66.74 |
| Rate for Payer: Aetna Commercial |
$53.53
|
| Rate for Payer: Anthem Medicaid |
$23.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.33
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cigna Commercial |
$57.70
|
| Rate for Payer: First Health Commercial |
$66.04
|
| Rate for Payer: Humana Commercial |
$59.09
|
| Rate for Payer: Humana KY Medicaid |
$23.91
|
| Rate for Payer: Humana Medicare Advantage |
$14.32
|
| Rate for Payer: Kentucky WC Medicaid |
$24.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.18
|
| Rate for Payer: Ohio Health Group HMO |
$52.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.55
|
| Rate for Payer: PHCS Commercial |
$66.74
|
| Rate for Payer: United Healthcare All Payer |
$61.18
|
|
|
INVEGA SUSTENNA 1MG (39MG)
|
Facility
|
IP
|
$69.52
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
636T0049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$66.74 |
| Rate for Payer: Aetna Commercial |
$53.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.23
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cigna Commercial |
$57.70
|
| Rate for Payer: First Health Commercial |
$66.04
|
| Rate for Payer: Humana Commercial |
$59.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.18
|
| Rate for Payer: Ohio Health Group HMO |
$52.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.55
|
| Rate for Payer: PHCS Commercial |
$66.74
|
| Rate for Payer: United Healthcare All Payer |
$61.18
|
|
|
INVEGA SUSTENNA 1MG (39MG)
|
Facility
|
IP
|
$69.52
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$66.74 |
| Rate for Payer: Aetna Commercial |
$53.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.23
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cigna Commercial |
$57.70
|
| Rate for Payer: First Health Commercial |
$66.04
|
| Rate for Payer: Humana Commercial |
$59.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.18
|
| Rate for Payer: Ohio Health Group HMO |
$52.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.55
|
| Rate for Payer: PHCS Commercial |
$66.74
|
| Rate for Payer: United Healthcare All Payer |
$61.18
|
|
|
INVEGA SUSTENNA 1MG (39MG)
|
Facility
|
IP
|
$3,159.58
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
25002290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$410.75 |
| Max. Negotiated Rate |
$3,033.20 |
| Rate for Payer: Aetna Commercial |
$2,432.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,464.47
|
| Rate for Payer: Cash Price |
$1,579.79
|
| Rate for Payer: Cigna Commercial |
$2,622.45
|
| Rate for Payer: First Health Commercial |
$3,001.60
|
| Rate for Payer: Humana Commercial |
$2,685.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,590.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,331.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$947.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,780.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,369.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$631.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$410.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$979.47
|
| Rate for Payer: PHCS Commercial |
$3,033.20
|
| Rate for Payer: United Healthcare All Payer |
$2,780.43
|
|
|
INVEGA SUSTENNA 1MG (39MG)
|
Professional
|
Both
|
$69.52
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$69.52 |
| Rate for Payer: Aetna Commercial |
$17.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$69.52
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.16
|
| Rate for Payer: Multiplan PHCS |
$41.71
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.66
|
| Rate for Payer: UHCCP Medicaid |
$24.33
|
|
|
INVEGA SUSTENNA 1MG (39MG)
|
Facility
|
OP
|
$3,159.58
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
25002290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$3,033.20 |
| Rate for Payer: Aetna Commercial |
$2,432.88
|
| Rate for Payer: Anthem Medicaid |
$1,086.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,464.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.33
|
| Rate for Payer: Cash Price |
$1,579.79
|
| Rate for Payer: Cash Price |
$1,579.79
|
| Rate for Payer: Cigna Commercial |
$2,622.45
|
| Rate for Payer: First Health Commercial |
$3,001.60
|
| Rate for Payer: Humana Commercial |
$2,685.64
|
| Rate for Payer: Humana KY Medicaid |
$1,086.58
|
| Rate for Payer: Humana Medicare Advantage |
$14.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,097.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,590.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,331.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,108.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,780.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,369.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$631.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$410.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$979.47
|
| Rate for Payer: PHCS Commercial |
$3,033.20
|
| Rate for Payer: United Healthcare All Payer |
$2,780.43
|
|
|
INVEGA SUSTENNA 1MG (39MG)
|
Facility
|
OP
|
$69.52
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$66.74 |
| Rate for Payer: Aetna Commercial |
$53.53
|
| Rate for Payer: Anthem Medicaid |
$23.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.33
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cigna Commercial |
$57.70
|
| Rate for Payer: First Health Commercial |
$66.04
|
| Rate for Payer: Humana Commercial |
$59.09
|
| Rate for Payer: Humana KY Medicaid |
$23.91
|
| Rate for Payer: Humana Medicare Advantage |
$14.32
|
| Rate for Payer: Kentucky WC Medicaid |
$24.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.18
|
| Rate for Payer: Ohio Health Group HMO |
$52.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.55
|
| Rate for Payer: PHCS Commercial |
$66.74
|
| Rate for Payer: United Healthcare All Payer |
$61.18
|
|
|
INVEGA SUSTENNA 1MG (78MG)
|
Facility
|
IP
|
$69.52
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$66.74 |
| Rate for Payer: Aetna Commercial |
$53.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.23
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cigna Commercial |
$57.70
|
| Rate for Payer: First Health Commercial |
$66.04
|
| Rate for Payer: Humana Commercial |
$59.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.18
|
| Rate for Payer: Ohio Health Group HMO |
$52.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.55
|
| Rate for Payer: PHCS Commercial |
$66.74
|
| Rate for Payer: United Healthcare All Payer |
$61.18
|
|
|
INVEGA SUSTENNA 1MG (78MG)
|
Facility
|
IP
|
$6,319.44
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
25002292
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$821.53 |
| Max. Negotiated Rate |
$6,066.66 |
| Rate for Payer: Aetna Commercial |
$4,865.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,929.16
|
| Rate for Payer: Cash Price |
$3,159.72
|
| Rate for Payer: Cigna Commercial |
$5,245.14
|
| Rate for Payer: First Health Commercial |
$6,003.47
|
| Rate for Payer: Humana Commercial |
$5,371.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,181.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,663.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,895.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,561.11
|
| Rate for Payer: Ohio Health Group HMO |
$4,739.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,263.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$821.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,959.03
|
| Rate for Payer: PHCS Commercial |
$6,066.66
|
| Rate for Payer: United Healthcare All Payer |
$5,561.11
|
|
