|
INVEGA SUSTENNA 1MG (78MG)
|
Facility
|
OP
|
$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 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
|
OP
|
$69.52
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
636T0051
|
|
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 |
636T0051
|
|
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
|
OP
|
$6,319.44
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
25002292
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$6,066.66 |
| Rate for Payer: Aetna Commercial |
$4,865.97
|
| Rate for Payer: Anthem Medicaid |
$2,173.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,929.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.33
|
| Rate for Payer: Cash Price |
$3,159.72
|
| 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: Humana KY Medicaid |
$2,173.26
|
| Rate for Payer: Humana Medicare Advantage |
$14.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,195.37
|
| 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 |
$17.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,216.86
|
| 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
|
|
|
INVEGA SUSTENNA 1MG (78MG)
|
Professional
|
Both
|
$69.52
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600051
|
|
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 TRINZA 1mg (273mg Syr)
|
Professional
|
Both
|
$59.25
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.74 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Buckeye Medicare Advantage |
$59.25
|
| Rate for Payer: Cash Price |
$29.62
|
| Rate for Payer: Multiplan PHCS |
$35.55
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$41.48
|
| Rate for Payer: UHCCP Medicaid |
$20.74
|
|
|
INVEGA TRINZA 1mg (273mg Syr)
|
Facility
|
IP
|
$59.25
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
636T0052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$56.88 |
| Rate for Payer: Aetna Commercial |
$45.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.22
|
| Rate for Payer: Cash Price |
$29.62
|
| Rate for Payer: Cigna Commercial |
$49.18
|
| Rate for Payer: First Health Commercial |
$56.29
|
| Rate for Payer: Humana Commercial |
$50.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.14
|
| Rate for Payer: Ohio Health Group HMO |
$44.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.37
|
| Rate for Payer: PHCS Commercial |
$56.88
|
| Rate for Payer: United Healthcare All Payer |
$52.14
|
|
|
INVEGA TRINZA 1mg (273mg Syr)
|
Facility
|
OP
|
$18,850.62
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
25002293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$18,096.60 |
| Rate for Payer: Aetna Commercial |
$14,514.98
|
| Rate for Payer: Anthem Medicaid |
$6,482.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,703.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.48
|
| Rate for Payer: Cash Price |
$9,425.31
|
| Rate for Payer: Cash Price |
$9,425.31
|
| Rate for Payer: Cigna Commercial |
$15,646.01
|
| Rate for Payer: First Health Commercial |
$17,908.09
|
| Rate for Payer: Humana Commercial |
$16,023.03
|
| Rate for Payer: Humana KY Medicaid |
$6,482.73
|
| Rate for Payer: Humana Medicare Advantage |
$12.21
|
| Rate for Payer: Kentucky WC Medicaid |
$6,548.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,457.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,911.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,612.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,588.55
|
| Rate for Payer: Ohio Health Group HMO |
$14,137.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,770.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,450.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,843.69
|
| Rate for Payer: PHCS Commercial |
$18,096.60
|
| Rate for Payer: United Healthcare All Payer |
$16,588.55
|
|
|
INVEGA TRINZA 1mg (273mg Syr)
|
Facility
|
OP
|
$59.25
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
636T0052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$56.88 |
| Rate for Payer: Aetna Commercial |
$45.62
|
| Rate for Payer: Anthem Medicaid |
$20.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.48
|
| Rate for Payer: Cash Price |
$29.62
|
| Rate for Payer: Cash Price |
$29.62
|
| Rate for Payer: Cigna Commercial |
$49.18
|
| Rate for Payer: First Health Commercial |
$56.29
|
| Rate for Payer: Humana Commercial |
$50.36
|
| Rate for Payer: Humana KY Medicaid |
$20.38
|
| Rate for Payer: Humana Medicare Advantage |
$12.21
|
| Rate for Payer: Kentucky WC Medicaid |
$20.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.14
|
| Rate for Payer: Ohio Health Group HMO |
$44.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.37
|
| Rate for Payer: PHCS Commercial |
$56.88
|
| Rate for Payer: United Healthcare All Payer |
$52.14
|
|
|
INVEGA TRINZA 1mg (273mg Syr)
|
Facility
|
IP
|
$59.25
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$56.88 |
| Rate for Payer: Aetna Commercial |
$45.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.22
|
| Rate for Payer: Cash Price |
$29.62
|
| Rate for Payer: Cigna Commercial |
$49.18
|
| Rate for Payer: First Health Commercial |
$56.29
|
| Rate for Payer: Humana Commercial |
$50.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.14
|
| Rate for Payer: Ohio Health Group HMO |
$44.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.37
|
| Rate for Payer: PHCS Commercial |
$56.88
|
| Rate for Payer: United Healthcare All Payer |
$52.14
|
|
|
INVEGA TRINZA 1mg (273mg Syr)
|
Facility
|
OP
|
$59.25
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$56.88 |
| Rate for Payer: Aetna Commercial |
$45.62
|
| Rate for Payer: Anthem Medicaid |
$20.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.48
|
| Rate for Payer: Cash Price |
$29.62
|
| Rate for Payer: Cash Price |
$29.62
|
| Rate for Payer: Cigna Commercial |
$49.18
|
| Rate for Payer: First Health Commercial |
$56.29
|
| Rate for Payer: Humana Commercial |
$50.36
|
| Rate for Payer: Humana KY Medicaid |
$20.38
|
| Rate for Payer: Humana Medicare Advantage |
$12.21
|
| Rate for Payer: Kentucky WC Medicaid |
$20.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.14
|
| Rate for Payer: Ohio Health Group HMO |
$44.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.37
|
| Rate for Payer: PHCS Commercial |
$56.88
|
| Rate for Payer: United Healthcare All Payer |
$52.14
|
|
|
INVEGA TRINZA 1mg (273mg Syr)
|
Facility
|
IP
|
$18,850.62
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
25002293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,450.58 |
| Max. Negotiated Rate |
$18,096.60 |
| Rate for Payer: Aetna Commercial |
$14,514.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,703.48
|
| Rate for Payer: Cash Price |
$9,425.31
|
| Rate for Payer: Cigna Commercial |
$15,646.01
|
| Rate for Payer: First Health Commercial |
$17,908.09
|
| Rate for Payer: Humana Commercial |
$16,023.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,457.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,911.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,655.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,588.55
|
| Rate for Payer: Ohio Health Group HMO |
$14,137.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,770.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,450.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,843.69
|
| Rate for Payer: PHCS Commercial |
$18,096.60
|
| Rate for Payer: United Healthcare All Payer |
$16,588.55
|
|
|
INVEGA TRINZA 1mg (410mg Syr)
|
Facility
|
IP
|
$59.29
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
636T0053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$45.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.25
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Cigna Commercial |
$49.21
|
| Rate for Payer: First Health Commercial |
$56.33
|
| Rate for Payer: Humana Commercial |
$50.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.18
|
| Rate for Payer: Ohio Health Group HMO |
$44.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.38
|
| Rate for Payer: PHCS Commercial |
$56.92
|
| Rate for Payer: United Healthcare All Payer |
$52.18
|
|
|
INVEGA TRINZA 1mg (410mg Syr)
|
Facility
|
OP
|
$59.29
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
636T0053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$45.65
|
| Rate for Payer: Anthem Medicaid |
$20.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.48
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Cigna Commercial |
$49.21
|
| Rate for Payer: First Health Commercial |
$56.33
|
| Rate for Payer: Humana Commercial |
$50.40
|
| Rate for Payer: Humana KY Medicaid |
$20.39
|
| Rate for Payer: Humana Medicare Advantage |
$12.21
|
| Rate for Payer: Kentucky WC Medicaid |
$20.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.18
|
| Rate for Payer: Ohio Health Group HMO |
$44.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.38
|
| Rate for Payer: PHCS Commercial |
$56.92
|
| Rate for Payer: United Healthcare All Payer |
$52.18
|
|
|
INVEGA TRINZA 1mg (410mg Syr)
|
Facility
|
OP
|
$28,330.30
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
25002294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$27,197.09 |
| Rate for Payer: Aetna Commercial |
$21,814.33
|
| Rate for Payer: Anthem Medicaid |
$9,742.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,097.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.48
|
| Rate for Payer: Cash Price |
$14,165.15
|
| Rate for Payer: Cash Price |
$14,165.15
|
| Rate for Payer: Cigna Commercial |
$23,514.15
|
| Rate for Payer: First Health Commercial |
$26,913.78
|
| Rate for Payer: Humana Commercial |
$24,080.76
|
| Rate for Payer: Humana KY Medicaid |
$9,742.79
|
| Rate for Payer: Humana Medicare Advantage |
$12.21
|
| Rate for Payer: Kentucky WC Medicaid |
$9,841.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,230.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,907.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,938.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,930.66
|
| Rate for Payer: Ohio Health Group HMO |
$21,247.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,666.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,682.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,782.39
|
| Rate for Payer: PHCS Commercial |
$27,197.09
|
| Rate for Payer: United Healthcare All Payer |
$24,930.66
|
|
|
INVEGA TRINZA 1mg (410mg Syr)
|
Professional
|
Both
|
$59.29
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.75 |
| Max. Negotiated Rate |
$59.29 |
| Rate for Payer: Buckeye Medicare Advantage |
$59.29
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Multiplan PHCS |
$35.57
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$41.50
|
| Rate for Payer: UHCCP Medicaid |
$20.75
|
|
|
INVEGA TRINZA 1mg (410mg Syr)
|
Facility
|
IP
|
$59.29
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$45.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.25
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Cigna Commercial |
$49.21
|
| Rate for Payer: First Health Commercial |
$56.33
|
| Rate for Payer: Humana Commercial |
$50.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.18
|
| Rate for Payer: Ohio Health Group HMO |
$44.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.38
|
| Rate for Payer: PHCS Commercial |
$56.92
|
| Rate for Payer: United Healthcare All Payer |
$52.18
|
|
|
INVEGA TRINZA 1mg (410mg Syr)
|
Facility
|
OP
|
$59.29
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$45.65
|
| Rate for Payer: Anthem Medicaid |
$20.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.48
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Cigna Commercial |
$49.21
|
| Rate for Payer: First Health Commercial |
$56.33
|
| Rate for Payer: Humana Commercial |
$50.40
|
| Rate for Payer: Humana KY Medicaid |
$20.39
|
| Rate for Payer: Humana Medicare Advantage |
$12.21
|
| Rate for Payer: Kentucky WC Medicaid |
$20.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.18
|
| Rate for Payer: Ohio Health Group HMO |
$44.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.38
|
| Rate for Payer: PHCS Commercial |
$56.92
|
| Rate for Payer: United Healthcare All Payer |
$52.18
|
|
|
INVEGA TRINZA 1mg (410mg Syr)
|
Facility
|
IP
|
$28,330.30
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
25002294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,682.94 |
| Max. Negotiated Rate |
$27,197.09 |
| Rate for Payer: Aetna Commercial |
$21,814.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,097.63
|
| Rate for Payer: Cash Price |
$14,165.15
|
| Rate for Payer: Cigna Commercial |
$23,514.15
|
| Rate for Payer: First Health Commercial |
$26,913.78
|
| Rate for Payer: Humana Commercial |
$24,080.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,230.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,907.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,499.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,930.66
|
| Rate for Payer: Ohio Health Group HMO |
$21,247.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,666.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,682.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,782.39
|
| Rate for Payer: PHCS Commercial |
$27,197.09
|
| Rate for Payer: United Healthcare All Payer |
$24,930.66
|
|
|
INVEGA TRINZA 1mg (546mg Syr)
|
Facility
|
IP
|
$59.59
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$57.21 |
| Rate for Payer: Aetna Commercial |
$45.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.48
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cigna Commercial |
$49.46
|
| Rate for Payer: First Health Commercial |
$56.61
|
| Rate for Payer: Humana Commercial |
$50.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.44
|
| Rate for Payer: Ohio Health Group HMO |
$44.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.47
|
| Rate for Payer: PHCS Commercial |
$57.21
|
| Rate for Payer: United Healthcare All Payer |
$52.44
|
|
|
INVEGA TRINZA 1mg (546mg Syr)
|
Facility
|
OP
|
$59.59
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
636T0054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$57.21 |
| Rate for Payer: Aetna Commercial |
$45.88
|
| Rate for Payer: Anthem Medicaid |
$20.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.48
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cigna Commercial |
$49.46
|
| Rate for Payer: First Health Commercial |
$56.61
|
| Rate for Payer: Humana Commercial |
$50.65
|
| Rate for Payer: Humana KY Medicaid |
$20.49
|
| Rate for Payer: Humana Medicare Advantage |
$12.21
|
| Rate for Payer: Kentucky WC Medicaid |
$20.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.44
|
| Rate for Payer: Ohio Health Group HMO |
$44.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.47
|
| Rate for Payer: PHCS Commercial |
$57.21
|
| Rate for Payer: United Healthcare All Payer |
$52.44
|
|
|
INVEGA TRINZA 1mg (546mg Syr)
|
Facility
|
OP
|
$37,918.76
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
25002295
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$36,402.01 |
| Rate for Payer: Aetna Commercial |
$29,197.45
|
| Rate for Payer: Anthem Medicaid |
$13,040.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,576.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.48
|
| Rate for Payer: Cash Price |
$18,959.38
|
| Rate for Payer: Cash Price |
$18,959.38
|
| Rate for Payer: Cigna Commercial |
$31,472.57
|
| Rate for Payer: First Health Commercial |
$36,022.82
|
| Rate for Payer: Humana Commercial |
$32,230.95
|
| Rate for Payer: Humana KY Medicaid |
$13,040.26
|
| Rate for Payer: Humana Medicare Advantage |
$12.21
|
| Rate for Payer: Kentucky WC Medicaid |
$13,172.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,093.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,984.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,301.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,368.51
|
| Rate for Payer: Ohio Health Group HMO |
$28,439.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,583.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,929.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,754.82
|
| Rate for Payer: PHCS Commercial |
$36,402.01
|
| Rate for Payer: United Healthcare All Payer |
$33,368.51
|
|
|
INVEGA TRINZA 1mg (546mg Syr)
|
Facility
|
OP
|
$59.59
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$57.21 |
| Rate for Payer: Aetna Commercial |
$45.88
|
| Rate for Payer: Anthem Medicaid |
$20.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.48
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cigna Commercial |
$49.46
|
| Rate for Payer: First Health Commercial |
$56.61
|
| Rate for Payer: Humana Commercial |
$50.65
|
| Rate for Payer: Humana KY Medicaid |
$20.49
|
| Rate for Payer: Humana Medicare Advantage |
$12.21
|
| Rate for Payer: Kentucky WC Medicaid |
$20.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.44
|
| Rate for Payer: Ohio Health Group HMO |
$44.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.47
|
| Rate for Payer: PHCS Commercial |
$57.21
|
| Rate for Payer: United Healthcare All Payer |
$52.44
|
|
|
INVEGA TRINZA 1mg (546mg Syr)
|
Facility
|
IP
|
$59.59
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
636T0054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$57.21 |
| Rate for Payer: Aetna Commercial |
$45.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.48
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cigna Commercial |
$49.46
|
| Rate for Payer: First Health Commercial |
$56.61
|
| Rate for Payer: Humana Commercial |
$50.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.44
|
| Rate for Payer: Ohio Health Group HMO |
$44.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.47
|
| Rate for Payer: PHCS Commercial |
$57.21
|
| Rate for Payer: United Healthcare All Payer |
$52.44
|
|
|
INVEGA TRINZA 1mg (546mg Syr)
|
Professional
|
Both
|
$59.59
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$59.59 |
| Rate for Payer: Buckeye Medicare Advantage |
$59.59
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Multiplan PHCS |
$35.75
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$41.71
|
| Rate for Payer: UHCCP Medicaid |
$20.86
|
|
