|
INVEGA SSTENNA 1MG (234MG)
|
Professional
|
Both
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$49.88 |
| Rate for Payer: Aetna Commercial |
$17.32
|
| Rate for Payer: Ambetter Exchange |
$15.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$15.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$15.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.10
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$15.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.08
|
| Rate for Payer: Multiplan PHCS |
$49.88
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$19.60
|
| Rate for Payer: UHCCP Medicaid |
$29.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.08
|
|
|
INVEGA SSTENNA 1MG (234MG)
|
Facility
|
OP
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$64.01
|
| Rate for Payer: Anthem Medicaid |
$28.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.36
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: First Health Commercial |
$78.97
|
| Rate for Payer: Humana Commercial |
$70.66
|
| Rate for Payer: Humana KY Medicaid |
$28.59
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Kentucky WC Medicaid |
$28.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.15
|
| Rate for Payer: Ohio Health Group HMO |
$62.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.36
|
| Rate for Payer: PHCS Commercial |
$79.80
|
| Rate for Payer: United Healthcare All Payer |
$73.15
|
|
|
INVEGA SSTENNA 1MG (234MG)
|
Facility
|
OP
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
636T0048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$64.01
|
| Rate for Payer: Anthem Medicaid |
$28.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.36
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: First Health Commercial |
$78.97
|
| Rate for Payer: Humana Commercial |
$70.66
|
| Rate for Payer: Humana KY Medicaid |
$28.59
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Kentucky WC Medicaid |
$28.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.15
|
| Rate for Payer: Ohio Health Group HMO |
$62.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.36
|
| Rate for Payer: PHCS Commercial |
$79.80
|
| Rate for Payer: United Healthcare All Payer |
$73.15
|
|
|
INVEGA SSTENNA 1MG (234MG)
|
Facility
|
IP
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
636T0048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.94 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$64.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.84
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: First Health Commercial |
$78.97
|
| Rate for Payer: Humana Commercial |
$70.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.15
|
| Rate for Payer: Ohio Health Group HMO |
$62.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.36
|
| Rate for Payer: PHCS Commercial |
$79.80
|
| Rate for Payer: United Healthcare All Payer |
$73.15
|
|
|
INVEGA SSTENNA 1MG (234MG)
|
Facility
|
OP
|
$19,451.87
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
25002289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$18,673.80 |
| Rate for Payer: Aetna Commercial |
$14,977.94
|
| Rate for Payer: Anthem Medicaid |
$6,689.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,172.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.36
|
| Rate for Payer: Cash Price |
$9,725.93
|
| Rate for Payer: Cash Price |
$9,725.93
|
| Rate for Payer: Cigna Commercial |
$16,145.05
|
| Rate for Payer: First Health Commercial |
$18,479.28
|
| Rate for Payer: Humana Commercial |
$16,534.09
|
| Rate for Payer: Humana KY Medicaid |
$6,689.50
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Kentucky WC Medicaid |
$6,757.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,950.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,355.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,823.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,117.65
|
| Rate for Payer: Ohio Health Group HMO |
$14,588.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,561.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,923.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,421.79
|
| Rate for Payer: PHCS Commercial |
$18,673.80
|
| Rate for Payer: United Healthcare All Payer |
$17,117.65
|
|
|
INVEGA SSTENNA 1MG (234MG)
|
Facility
|
IP
|
$19,451.87
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
25002289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,835.56 |
| Max. Negotiated Rate |
$18,673.80 |
| Rate for Payer: Aetna Commercial |
$14,977.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,172.46
|
| Rate for Payer: Cash Price |
$9,725.93
|
| Rate for Payer: Cigna Commercial |
$16,145.05
|
| Rate for Payer: First Health Commercial |
$18,479.28
|
| Rate for Payer: Humana Commercial |
$16,534.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,950.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,355.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,835.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,117.65
|
| Rate for Payer: Ohio Health Group HMO |
$14,588.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,561.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,923.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,421.79
|
| Rate for Payer: PHCS Commercial |
$18,673.80
|
| Rate for Payer: United Healthcare All Payer |
$17,117.65
|
|
|
INVEGA SSTENNA 1MG (234MG)
|
Facility
|
IP
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.94 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$64.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.84
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: First Health Commercial |
$78.97
|
| Rate for Payer: Humana Commercial |
$70.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.15
|
| Rate for Payer: Ohio Health Group HMO |
$62.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.36
|
| Rate for Payer: PHCS Commercial |
$79.80
|
| Rate for Payer: United Healthcare All Payer |
$73.15
|
|
|
INVEGA SUSTENNA 1MG (117MG)
|
Facility
|
IP
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
636T0050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.94 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$64.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.84
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: First Health Commercial |
$78.97
|
| Rate for Payer: Humana Commercial |
$70.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.15
|
| Rate for Payer: Ohio Health Group HMO |
$62.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.36
|
| Rate for Payer: PHCS Commercial |
$79.80
|
| Rate for Payer: United Healthcare All Payer |
$73.15
|
|
|
INVEGA SUSTENNA 1MG (117MG)
|
Facility
|
OP
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$64.01
|
| Rate for Payer: Anthem Medicaid |
$28.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.36
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: First Health Commercial |
$78.97
|
| Rate for Payer: Humana Commercial |
$70.66
|
| Rate for Payer: Humana KY Medicaid |
$28.59
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Kentucky WC Medicaid |
$28.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.15
|
| Rate for Payer: Ohio Health Group HMO |
$62.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.36
|
| Rate for Payer: PHCS Commercial |
$79.80
|
| Rate for Payer: United Healthcare All Payer |
$73.15
|
|
|
INVEGA SUSTENNA 1MG (117MG)
|
Facility
|
OP
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
636T0050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$64.01
|
| Rate for Payer: Anthem Medicaid |
$28.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.36
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: First Health Commercial |
$78.97
|
| Rate for Payer: Humana Commercial |
$70.66
|
| Rate for Payer: Humana KY Medicaid |
$28.59
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Kentucky WC Medicaid |
$28.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.15
|
| Rate for Payer: Ohio Health Group HMO |
$62.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.36
|
| Rate for Payer: PHCS Commercial |
$79.80
|
| Rate for Payer: United Healthcare All Payer |
$73.15
|
|
|
INVEGA SUSTENNA 1MG (117MG)
|
Professional
|
Both
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$49.88 |
| Rate for Payer: Aetna Commercial |
$17.32
|
| Rate for Payer: Ambetter Exchange |
$15.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$15.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$15.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.10
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$15.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.08
|
| Rate for Payer: Multiplan PHCS |
$49.88
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$19.60
|
| Rate for Payer: UHCCP Medicaid |
$29.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.08
|
|
|
INVEGA SUSTENNA 1MG (117MG)
|
Facility
|
OP
|
$9,725.80
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
25002291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$9,336.77 |
| Rate for Payer: Aetna Commercial |
$7,488.87
|
| Rate for Payer: Anthem Medicaid |
$3,344.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,586.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.36
|
| Rate for Payer: Cash Price |
$4,862.90
|
| Rate for Payer: Cash Price |
$4,862.90
|
| Rate for Payer: Cigna Commercial |
$8,072.41
|
| Rate for Payer: First Health Commercial |
$9,239.51
|
| Rate for Payer: Humana Commercial |
$8,266.93
|
| Rate for Payer: Humana KY Medicaid |
$3,344.70
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,378.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,975.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,177.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,411.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,558.70
|
| Rate for Payer: Ohio Health Group HMO |
$7,294.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,780.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,461.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,710.80
|
| Rate for Payer: PHCS Commercial |
$9,336.77
|
| Rate for Payer: United Healthcare All Payer |
$8,558.70
|
|
|
INVEGA SUSTENNA 1MG (117MG)
|
Facility
|
IP
|
$9,725.80
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
25002291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,917.74 |
| Max. Negotiated Rate |
$9,336.77 |
| Rate for Payer: Aetna Commercial |
$7,488.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,586.12
|
| Rate for Payer: Cash Price |
$4,862.90
|
| Rate for Payer: Cigna Commercial |
$8,072.41
|
| Rate for Payer: First Health Commercial |
$9,239.51
|
| Rate for Payer: Humana Commercial |
$8,266.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,975.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,177.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,917.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,558.70
|
| Rate for Payer: Ohio Health Group HMO |
$7,294.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,780.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,461.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,710.80
|
| Rate for Payer: PHCS Commercial |
$9,336.77
|
| Rate for Payer: United Healthcare All Payer |
$8,558.70
|
|
|
INVEGA SUSTENNA 1MG (117MG)
|
Facility
|
IP
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.94 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$64.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.84
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: First Health Commercial |
$78.97
|
| Rate for Payer: Humana Commercial |
$70.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.15
|
| Rate for Payer: Ohio Health Group HMO |
$62.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.36
|
| Rate for Payer: PHCS Commercial |
$79.80
|
| Rate for Payer: United Healthcare All Payer |
$73.15
|
|
|
INVEGA SUSTENNA 1MG (156MG)
|
Facility
|
OP
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$64.01
|
| Rate for Payer: Anthem Medicaid |
$28.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.36
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: First Health Commercial |
$78.97
|
| Rate for Payer: Humana Commercial |
$70.66
|
| Rate for Payer: Humana KY Medicaid |
$28.59
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Kentucky WC Medicaid |
$28.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.15
|
| Rate for Payer: Ohio Health Group HMO |
$62.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.36
|
| Rate for Payer: PHCS Commercial |
$79.80
|
| Rate for Payer: United Healthcare All Payer |
$73.15
|
|
|
INVEGA SUSTENNA 1MG (156MG)
|
Facility
|
IP
|
$12,968.22
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
25002288
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,890.47 |
| Max. Negotiated Rate |
$12,449.49 |
| Rate for Payer: Aetna Commercial |
$9,985.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,115.21
|
| Rate for Payer: Cash Price |
$6,484.11
|
| Rate for Payer: Cigna Commercial |
$10,763.62
|
| Rate for Payer: First Health Commercial |
$12,319.81
|
| Rate for Payer: Humana Commercial |
$11,022.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,633.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,570.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,890.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,412.03
|
| Rate for Payer: Ohio Health Group HMO |
$9,726.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,374.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,282.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,948.07
|
| Rate for Payer: PHCS Commercial |
$12,449.49
|
| Rate for Payer: United Healthcare All Payer |
$11,412.03
|
|
|
INVEGA SUSTENNA 1MG (156MG)
|
Facility
|
IP
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.94 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$64.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.84
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: First Health Commercial |
$78.97
|
| Rate for Payer: Humana Commercial |
$70.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.15
|
| Rate for Payer: Ohio Health Group HMO |
$62.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.36
|
| Rate for Payer: PHCS Commercial |
$79.80
|
| Rate for Payer: United Healthcare All Payer |
$73.15
|
|
|
INVEGA SUSTENNA 1MG (156MG)
|
Professional
|
Both
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$49.88 |
| Rate for Payer: Aetna Commercial |
$17.32
|
| Rate for Payer: Ambetter Exchange |
$15.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$15.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$15.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.10
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$15.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.08
|
| Rate for Payer: Multiplan PHCS |
$49.88
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$19.60
|
| Rate for Payer: UHCCP Medicaid |
$29.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.08
|
|
|
INVEGA SUSTENNA 1MG (156MG)
|
Facility
|
OP
|
$12,968.22
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
25002288
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$12,449.49 |
| Rate for Payer: Aetna Commercial |
$9,985.53
|
| Rate for Payer: Anthem Medicaid |
$4,459.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,115.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.36
|
| Rate for Payer: Cash Price |
$6,484.11
|
| Rate for Payer: Cash Price |
$6,484.11
|
| Rate for Payer: Cigna Commercial |
$10,763.62
|
| Rate for Payer: First Health Commercial |
$12,319.81
|
| Rate for Payer: Humana Commercial |
$11,022.99
|
| Rate for Payer: Humana KY Medicaid |
$4,459.77
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Kentucky WC Medicaid |
$4,505.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,633.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,570.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,549.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,412.03
|
| Rate for Payer: Ohio Health Group HMO |
$9,726.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,374.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,282.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,948.07
|
| Rate for Payer: PHCS Commercial |
$12,449.49
|
| Rate for Payer: United Healthcare All Payer |
$11,412.03
|
|
|
INVEGA SUSTENNA 1MG (156MG)
|
Facility
|
OP
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
636T0047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$64.01
|
| Rate for Payer: Anthem Medicaid |
$28.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.36
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: First Health Commercial |
$78.97
|
| Rate for Payer: Humana Commercial |
$70.66
|
| Rate for Payer: Humana KY Medicaid |
$28.59
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Kentucky WC Medicaid |
$28.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.15
|
| Rate for Payer: Ohio Health Group HMO |
$62.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.36
|
| Rate for Payer: PHCS Commercial |
$79.80
|
| Rate for Payer: United Healthcare All Payer |
$73.15
|
|
|
INVEGA SUSTENNA 1MG (156MG)
|
Facility
|
IP
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
636T0047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.94 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$64.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.84
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: First Health Commercial |
$78.97
|
| Rate for Payer: Humana Commercial |
$70.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.15
|
| Rate for Payer: Ohio Health Group HMO |
$62.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.36
|
| Rate for Payer: PHCS Commercial |
$79.80
|
| Rate for Payer: United Healthcare All Payer |
$73.15
|
|
|
INVEGA SUSTENNA 1MG (39MG)
|
Facility
|
OP
|
$3,241.71
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
25002290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$3,112.04 |
| Rate for Payer: Aetna Commercial |
$2,496.12
|
| Rate for Payer: Anthem Medicaid |
$1,114.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,528.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.36
|
| Rate for Payer: Cash Price |
$1,620.86
|
| Rate for Payer: Cash Price |
$1,620.86
|
| Rate for Payer: Cigna Commercial |
$2,690.62
|
| Rate for Payer: First Health Commercial |
$3,079.62
|
| Rate for Payer: Humana Commercial |
$2,755.45
|
| Rate for Payer: Humana KY Medicaid |
$1,114.82
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,126.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,658.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,392.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,137.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,852.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,431.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,593.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,820.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,236.78
|
| Rate for Payer: PHCS Commercial |
$3,112.04
|
| Rate for Payer: United Healthcare All Payer |
$2,852.70
|
|
|
INVEGA SUSTENNA 1MG (39MG)
|
Facility
|
IP
|
$3,241.71
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
25002290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$972.51 |
| Max. Negotiated Rate |
$3,112.04 |
| Rate for Payer: Aetna Commercial |
$2,496.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,528.53
|
| Rate for Payer: Cash Price |
$1,620.86
|
| Rate for Payer: Cigna Commercial |
$2,690.62
|
| Rate for Payer: First Health Commercial |
$3,079.62
|
| Rate for Payer: Humana Commercial |
$2,755.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,658.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,392.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$972.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,852.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,431.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,593.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,820.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,236.78
|
| Rate for Payer: PHCS Commercial |
$3,112.04
|
| Rate for Payer: United Healthcare All Payer |
$2,852.70
|
|
|
INVEGA SUSTENNA 1MG (39MG)
|
Facility
|
IP
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
636T0049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.94 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$64.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.84
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: First Health Commercial |
$78.97
|
| Rate for Payer: Humana Commercial |
$70.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.15
|
| Rate for Payer: Ohio Health Group HMO |
$62.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.36
|
| Rate for Payer: PHCS Commercial |
$79.80
|
| Rate for Payer: United Healthcare All Payer |
$73.15
|
|
|
INVEGA SUSTENNA 1MG (39MG)
|
Facility
|
IP
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.94 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$64.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.84
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: First Health Commercial |
$78.97
|
| Rate for Payer: Humana Commercial |
$70.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.15
|
| Rate for Payer: Ohio Health Group HMO |
$62.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.36
|
| Rate for Payer: PHCS Commercial |
$79.80
|
| Rate for Payer: United Healthcare All Payer |
$73.15
|
|
