|
INVEGA SUSTENNA 1MG (39MG)
|
Facility
|
OP
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600049
|
|
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 (39MG)
|
Facility
|
OP
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
636T0049
|
|
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 (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 (78MG)
|
Facility
|
IP
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
636T0051
|
|
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 (78MG)
|
Facility
|
IP
|
$6,483.76
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
25002292
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,945.13 |
| Max. Negotiated Rate |
$6,224.41 |
| Rate for Payer: Aetna Commercial |
$4,992.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,057.33
|
| Rate for Payer: Cash Price |
$3,241.88
|
| Rate for Payer: Cigna Commercial |
$5,381.52
|
| Rate for Payer: First Health Commercial |
$6,159.57
|
| Rate for Payer: Humana Commercial |
$5,511.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,316.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,785.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,945.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,705.71
|
| Rate for Payer: Ohio Health Group HMO |
$4,862.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,187.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,640.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,473.79
|
| Rate for Payer: PHCS Commercial |
$6,224.41
|
| Rate for Payer: United Healthcare All Payer |
$5,705.71
|
|
|
INVEGA SUSTENNA 1MG (78MG)
|
Facility
|
OP
|
$6,483.76
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
25002292
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$6,224.41 |
| Rate for Payer: Aetna Commercial |
$4,992.50
|
| Rate for Payer: Anthem Medicaid |
$2,229.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,057.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.36
|
| Rate for Payer: Cash Price |
$3,241.88
|
| Rate for Payer: Cash Price |
$3,241.88
|
| Rate for Payer: Cigna Commercial |
$5,381.52
|
| Rate for Payer: First Health Commercial |
$6,159.57
|
| Rate for Payer: Humana Commercial |
$5,511.20
|
| Rate for Payer: Humana KY Medicaid |
$2,229.77
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,252.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,316.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,785.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,274.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,705.71
|
| Rate for Payer: Ohio Health Group HMO |
$4,862.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,187.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,640.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,473.79
|
| Rate for Payer: PHCS Commercial |
$6,224.41
|
| Rate for Payer: United Healthcare All Payer |
$5,705.71
|
|
|
INVEGA SUSTENNA 1MG (78MG)
|
Facility
|
OP
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
636T0051
|
|
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 (78MG)
|
Professional
|
Both
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600051
|
|
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 (78MG)
|
Facility
|
IP
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600051
|
|
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 (78MG)
|
Facility
|
OP
|
$83.13
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
63600051
|
|
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 TRINZA 1mg (273mg Syr)
|
Facility
|
OP
|
$70.89
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Anthem Medicaid |
$24.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.50
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cigna Commercial |
$58.84
|
| Rate for Payer: First Health Commercial |
$67.35
|
| Rate for Payer: Humana Commercial |
$60.26
|
| Rate for Payer: Humana KY Medicaid |
$24.38
|
| Rate for Payer: Humana Medicare Advantage |
$12.96
|
| Rate for Payer: Kentucky WC Medicaid |
$24.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.38
|
| Rate for Payer: Ohio Health Group HMO |
$53.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.91
|
| Rate for Payer: PHCS Commercial |
$68.05
|
| Rate for Payer: United Healthcare All Payer |
$62.38
|
|
|
INVEGA TRINZA 1mg (273mg Syr)
|
Facility
|
IP
|
$70.89
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.27 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.29
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cigna Commercial |
$58.84
|
| Rate for Payer: First Health Commercial |
$67.35
|
| Rate for Payer: Humana Commercial |
$60.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.38
|
| Rate for Payer: Ohio Health Group HMO |
$53.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.91
|
| Rate for Payer: PHCS Commercial |
$68.05
|
| Rate for Payer: United Healthcare All Payer |
$62.38
|
|
|
INVEGA TRINZA 1mg (273mg Syr)
|
Professional
|
Both
|
$70.89
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$42.53 |
| Rate for Payer: Ambetter Exchange |
$12.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$12.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$12.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.55
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$12.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.96
|
| Rate for Payer: Multiplan PHCS |
$42.53
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$16.85
|
| Rate for Payer: UHCCP Medicaid |
$24.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.96
|
|
|
INVEGA TRINZA 1mg (273mg Syr)
|
Facility
|
IP
|
$19,340.74
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
25002293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,802.22 |
| Max. Negotiated Rate |
$18,567.11 |
| Rate for Payer: Aetna Commercial |
$14,892.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,085.78
|
| Rate for Payer: Cash Price |
$9,670.37
|
| Rate for Payer: Cigna Commercial |
$16,052.81
|
| Rate for Payer: First Health Commercial |
$18,373.70
|
| Rate for Payer: Humana Commercial |
$16,439.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,859.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,273.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,802.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,019.85
|
| Rate for Payer: Ohio Health Group HMO |
$14,505.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,472.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,826.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,345.11
|
| Rate for Payer: PHCS Commercial |
$18,567.11
|
| Rate for Payer: United Healthcare All Payer |
$17,019.85
|
|
|
INVEGA TRINZA 1mg (273mg Syr)
|
Facility
|
IP
|
$70.89
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
636T0052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.27 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.29
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cigna Commercial |
$58.84
|
| Rate for Payer: First Health Commercial |
$67.35
|
| Rate for Payer: Humana Commercial |
$60.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.38
|
| Rate for Payer: Ohio Health Group HMO |
$53.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.91
|
| Rate for Payer: PHCS Commercial |
$68.05
|
| Rate for Payer: United Healthcare All Payer |
$62.38
|
|
|
INVEGA TRINZA 1mg (273mg Syr)
|
Facility
|
OP
|
$70.89
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
636T0052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Anthem Medicaid |
$24.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.50
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cigna Commercial |
$58.84
|
| Rate for Payer: First Health Commercial |
$67.35
|
| Rate for Payer: Humana Commercial |
$60.26
|
| Rate for Payer: Humana KY Medicaid |
$24.38
|
| Rate for Payer: Humana Medicare Advantage |
$12.96
|
| Rate for Payer: Kentucky WC Medicaid |
$24.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.38
|
| Rate for Payer: Ohio Health Group HMO |
$53.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.91
|
| Rate for Payer: PHCS Commercial |
$68.05
|
| Rate for Payer: United Healthcare All Payer |
$62.38
|
|
|
INVEGA TRINZA 1mg (273mg Syr)
|
Facility
|
OP
|
$19,340.74
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
25002293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$18,567.11 |
| Rate for Payer: Aetna Commercial |
$14,892.37
|
| Rate for Payer: Anthem Medicaid |
$6,651.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,085.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.50
|
| Rate for Payer: Cash Price |
$9,670.37
|
| Rate for Payer: Cash Price |
$9,670.37
|
| Rate for Payer: Cigna Commercial |
$16,052.81
|
| Rate for Payer: First Health Commercial |
$18,373.70
|
| Rate for Payer: Humana Commercial |
$16,439.63
|
| Rate for Payer: Humana KY Medicaid |
$6,651.28
|
| Rate for Payer: Humana Medicare Advantage |
$12.96
|
| Rate for Payer: Kentucky WC Medicaid |
$6,718.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,859.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,273.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,784.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,019.85
|
| Rate for Payer: Ohio Health Group HMO |
$14,505.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,472.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,826.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,345.11
|
| Rate for Payer: PHCS Commercial |
$18,567.11
|
| Rate for Payer: United Healthcare All Payer |
$17,019.85
|
|
|
INVEGA TRINZA 1mg (410mg Syr)
|
Facility
|
IP
|
$29,066.87
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
25002294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,720.06 |
| Max. Negotiated Rate |
$27,904.20 |
| Rate for Payer: Aetna Commercial |
$22,381.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,672.16
|
| Rate for Payer: Cash Price |
$14,533.43
|
| Rate for Payer: Cigna Commercial |
$24,125.50
|
| Rate for Payer: First Health Commercial |
$27,613.53
|
| Rate for Payer: Humana Commercial |
$24,706.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,834.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,451.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,720.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,578.85
|
| Rate for Payer: Ohio Health Group HMO |
$21,800.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,253.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,288.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,056.14
|
| Rate for Payer: PHCS Commercial |
$27,904.20
|
| Rate for Payer: United Healthcare All Payer |
$25,578.85
|
|
|
INVEGA TRINZA 1mg (410mg Syr)
|
Facility
|
OP
|
$70.89
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
636T0053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Anthem Medicaid |
$24.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.50
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cigna Commercial |
$58.84
|
| Rate for Payer: First Health Commercial |
$67.35
|
| Rate for Payer: Humana Commercial |
$60.26
|
| Rate for Payer: Humana KY Medicaid |
$24.38
|
| Rate for Payer: Humana Medicare Advantage |
$12.96
|
| Rate for Payer: Kentucky WC Medicaid |
$24.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.38
|
| Rate for Payer: Ohio Health Group HMO |
$53.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.91
|
| Rate for Payer: PHCS Commercial |
$68.05
|
| Rate for Payer: United Healthcare All Payer |
$62.38
|
|
|
INVEGA TRINZA 1mg (410mg Syr)
|
Professional
|
Both
|
$70.89
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$42.53 |
| Rate for Payer: Ambetter Exchange |
$12.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$12.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$12.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.55
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$12.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.96
|
| Rate for Payer: Multiplan PHCS |
$42.53
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$16.85
|
| Rate for Payer: UHCCP Medicaid |
$24.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.96
|
|
|
INVEGA TRINZA 1mg (410mg Syr)
|
Facility
|
IP
|
$70.89
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
636T0053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.27 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.29
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cigna Commercial |
$58.84
|
| Rate for Payer: First Health Commercial |
$67.35
|
| Rate for Payer: Humana Commercial |
$60.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.38
|
| Rate for Payer: Ohio Health Group HMO |
$53.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.91
|
| Rate for Payer: PHCS Commercial |
$68.05
|
| Rate for Payer: United Healthcare All Payer |
$62.38
|
|
|
INVEGA TRINZA 1mg (410mg Syr)
|
Facility
|
OP
|
$29,066.87
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
25002294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$27,904.20 |
| Rate for Payer: Aetna Commercial |
$22,381.49
|
| Rate for Payer: Anthem Medicaid |
$9,996.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,672.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.50
|
| Rate for Payer: Cash Price |
$14,533.43
|
| Rate for Payer: Cash Price |
$14,533.43
|
| Rate for Payer: Cigna Commercial |
$24,125.50
|
| Rate for Payer: First Health Commercial |
$27,613.53
|
| Rate for Payer: Humana Commercial |
$24,706.84
|
| Rate for Payer: Humana KY Medicaid |
$9,996.10
|
| Rate for Payer: Humana Medicare Advantage |
$12.96
|
| Rate for Payer: Kentucky WC Medicaid |
$10,097.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,834.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,451.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,196.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,578.85
|
| Rate for Payer: Ohio Health Group HMO |
$21,800.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,253.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,288.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,056.14
|
| Rate for Payer: PHCS Commercial |
$27,904.20
|
| Rate for Payer: United Healthcare All Payer |
$25,578.85
|
|
|
INVEGA TRINZA 1mg (410mg Syr)
|
Facility
|
IP
|
$70.89
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.27 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.29
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cigna Commercial |
$58.84
|
| Rate for Payer: First Health Commercial |
$67.35
|
| Rate for Payer: Humana Commercial |
$60.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.38
|
| Rate for Payer: Ohio Health Group HMO |
$53.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.91
|
| Rate for Payer: PHCS Commercial |
$68.05
|
| Rate for Payer: United Healthcare All Payer |
$62.38
|
|
|
INVEGA TRINZA 1mg (410mg Syr)
|
Facility
|
OP
|
$70.89
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Anthem Medicaid |
$24.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.50
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cigna Commercial |
$58.84
|
| Rate for Payer: First Health Commercial |
$67.35
|
| Rate for Payer: Humana Commercial |
$60.26
|
| Rate for Payer: Humana KY Medicaid |
$24.38
|
| Rate for Payer: Humana Medicare Advantage |
$12.96
|
| Rate for Payer: Kentucky WC Medicaid |
$24.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.38
|
| Rate for Payer: Ohio Health Group HMO |
$53.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.91
|
| Rate for Payer: PHCS Commercial |
$68.05
|
| Rate for Payer: United Healthcare All Payer |
$62.38
|
|
|
INVEGA TRINZA 1mg (546mg Syr)
|
Professional
|
Both
|
$70.89
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$42.53 |
| Rate for Payer: Ambetter Exchange |
$12.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$12.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$12.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.55
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$12.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.96
|
| Rate for Payer: Multiplan PHCS |
$42.53
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$16.85
|
| Rate for Payer: UHCCP Medicaid |
$24.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.96
|
|
