RISPERDAL(0.5MG)12.5MG ER SYR
|
Facility
|
IP
|
$64.54
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
636T0219
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$8.39 |
Max. Negotiated Rate |
$61.96 |
Rate for Payer: Aetna Commercial |
$49.70
|
Rate for Payer: Anthem POS/PPO/Traditional |
$50.34
|
Rate for Payer: Cash Price |
$32.27
|
Rate for Payer: Cigna Commercial |
$53.57
|
Rate for Payer: First Health Commercial |
$61.31
|
Rate for Payer: Humana Commercial |
$54.86
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$52.92
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.63
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$19.36
|
Rate for Payer: Ohio Health Choice Commercial |
$56.80
|
Rate for Payer: Ohio Health Group HMO |
$48.40
|
Rate for Payer: Ohio Health Group PPO Differential |
$12.91
|
Rate for Payer: Ohio Health Group PPO No Differential |
$8.39
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.01
|
Rate for Payer: PHCS Commercial |
$61.96
|
Rate for Payer: United Healthcare All Payer |
$56.80
|
|
RISPERDAL(0.5MG)12.5MG ER SYR
|
Facility
|
OP
|
$64.54
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
636T0219
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$8.39 |
Max. Negotiated Rate |
$61.96 |
Rate for Payer: Aetna Commercial |
$49.70
|
Rate for Payer: Anthem Medicaid |
$22.20
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$12.15
|
Rate for Payer: Anthem POS/PPO/Traditional |
$50.34
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.01
|
Rate for Payer: CareSource Just4Me Medicare |
$16.40
|
Rate for Payer: Cash Price |
$32.27
|
Rate for Payer: Cash Price |
$32.27
|
Rate for Payer: Cigna Commercial |
$53.57
|
Rate for Payer: First Health Commercial |
$61.31
|
Rate for Payer: Humana Commercial |
$54.86
|
Rate for Payer: Humana KY Medicaid |
$22.20
|
Rate for Payer: Humana Medicare Advantage |
$12.15
|
Rate for Payer: Kentucky WC Medicaid |
$22.42
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$52.92
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.63
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$14.58
|
Rate for Payer: Molina Healthcare Medicaid |
$22.64
|
Rate for Payer: Ohio Health Choice Commercial |
$56.80
|
Rate for Payer: Ohio Health Group HMO |
$48.40
|
Rate for Payer: Ohio Health Group PPO Differential |
$12.91
|
Rate for Payer: Ohio Health Group PPO No Differential |
$8.39
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.01
|
Rate for Payer: PHCS Commercial |
$61.96
|
Rate for Payer: United Healthcare All Payer |
$56.80
|
|
RISPERDAL CONST0.5MG 12.5MGINJ
|
Facility
|
OP
|
$1,674.84
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
25002345
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$12.15 |
Max. Negotiated Rate |
$1,607.85 |
Rate for Payer: Aetna Commercial |
$1,289.63
|
Rate for Payer: Anthem Medicaid |
$575.98
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$12.15
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,306.38
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.01
|
Rate for Payer: CareSource Just4Me Medicare |
$16.40
|
Rate for Payer: Cash Price |
$837.42
|
Rate for Payer: Cash Price |
$837.42
|
Rate for Payer: Cigna Commercial |
$1,390.12
|
Rate for Payer: First Health Commercial |
$1,591.10
|
Rate for Payer: Humana Commercial |
$1,423.61
|
Rate for Payer: Humana KY Medicaid |
$575.98
|
Rate for Payer: Humana Medicare Advantage |
$12.15
|
Rate for Payer: Kentucky WC Medicaid |
$581.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,373.37
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,236.03
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$14.58
|
Rate for Payer: Molina Healthcare Medicaid |
$587.53
|
Rate for Payer: Ohio Health Choice Commercial |
$1,473.86
|
Rate for Payer: Ohio Health Group HMO |
$1,256.13
|
Rate for Payer: Ohio Health Group PPO Differential |
$334.97
|
Rate for Payer: Ohio Health Group PPO No Differential |
$217.73
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$519.20
|
Rate for Payer: PHCS Commercial |
$1,607.85
|
Rate for Payer: United Healthcare All Payer |
$1,473.86
|
|
RISPERDAL CONST0.5MG 12.5MGINJ
|
Facility
|
IP
|
$1,674.84
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
25002345
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$217.73 |
Max. Negotiated Rate |
$1,607.85 |
Rate for Payer: Aetna Commercial |
$1,289.63
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,306.38
|
Rate for Payer: Cash Price |
$837.42
|
Rate for Payer: Cigna Commercial |
$1,390.12
|
Rate for Payer: First Health Commercial |
$1,591.10
|
Rate for Payer: Humana Commercial |
$1,423.61
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,373.37
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,236.03
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$502.45
|
Rate for Payer: Ohio Health Choice Commercial |
$1,473.86
|
Rate for Payer: Ohio Health Group HMO |
$1,256.13
|
Rate for Payer: Ohio Health Group PPO Differential |
$334.97
|
Rate for Payer: Ohio Health Group PPO No Differential |
$217.73
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$519.20
|
Rate for Payer: PHCS Commercial |
$1,607.85
|
Rate for Payer: United Healthcare All Payer |
$1,473.86
|
|
RISPERDAL CONST 0.5MG 37.5MG V
|
Facility
|
OP
|
$5,024.25
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
25002347
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$12.15 |
Max. Negotiated Rate |
$4,823.28 |
Rate for Payer: Aetna Commercial |
$3,868.67
|
Rate for Payer: Anthem Medicaid |
$1,727.84
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$12.15
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,918.92
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.01
|
Rate for Payer: CareSource Just4Me Medicare |
$16.40
|
Rate for Payer: Cash Price |
$2,512.12
|
Rate for Payer: Cash Price |
$2,512.12
|
Rate for Payer: Cigna Commercial |
$4,170.13
|
Rate for Payer: First Health Commercial |
$4,773.04
|
Rate for Payer: Humana Commercial |
$4,270.61
|
Rate for Payer: Humana KY Medicaid |
$1,727.84
|
Rate for Payer: Humana Medicare Advantage |
$12.15
|
Rate for Payer: Kentucky WC Medicaid |
$1,745.42
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,119.88
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,707.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$14.58
|
Rate for Payer: Molina Healthcare Medicaid |
$1,762.51
|
Rate for Payer: Ohio Health Choice Commercial |
$4,421.34
|
Rate for Payer: Ohio Health Group HMO |
$3,768.19
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,004.85
|
Rate for Payer: Ohio Health Group PPO No Differential |
$653.15
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,557.52
|
Rate for Payer: PHCS Commercial |
$4,823.28
|
Rate for Payer: United Healthcare All Payer |
$4,421.34
|
|
RISPERDAL CONST 0.5MG 37.5MG V
|
Facility
|
IP
|
$5,024.25
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
25002347
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$653.15 |
Max. Negotiated Rate |
$4,823.28 |
Rate for Payer: Aetna Commercial |
$3,868.67
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,918.92
|
Rate for Payer: Cash Price |
$2,512.12
|
Rate for Payer: Cigna Commercial |
$4,170.13
|
Rate for Payer: First Health Commercial |
$4,773.04
|
Rate for Payer: Humana Commercial |
$4,270.61
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,119.88
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,707.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,507.28
|
Rate for Payer: Ohio Health Choice Commercial |
$4,421.34
|
Rate for Payer: Ohio Health Group HMO |
$3,768.19
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,004.85
|
Rate for Payer: Ohio Health Group PPO No Differential |
$653.15
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,557.52
|
Rate for Payer: PHCS Commercial |
$4,823.28
|
Rate for Payer: United Healthcare All Payer |
$4,421.34
|
|
RISPERDALCONSTA(0.5MG)25mg SYR
|
Facility
|
IP
|
$3,349.35
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
25002348
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$435.42 |
Max. Negotiated Rate |
$3,215.38 |
Rate for Payer: Aetna Commercial |
$2,579.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,612.49
|
Rate for Payer: Cash Price |
$1,674.67
|
Rate for Payer: Cigna Commercial |
$2,779.96
|
Rate for Payer: First Health Commercial |
$3,181.88
|
Rate for Payer: Humana Commercial |
$2,846.95
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,746.47
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,471.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,004.80
|
Rate for Payer: Ohio Health Choice Commercial |
$2,947.43
|
Rate for Payer: Ohio Health Group HMO |
$2,512.01
|
Rate for Payer: Ohio Health Group PPO Differential |
$669.87
|
Rate for Payer: Ohio Health Group PPO No Differential |
$435.42
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,038.30
|
Rate for Payer: PHCS Commercial |
$3,215.38
|
Rate for Payer: United Healthcare All Payer |
$2,947.43
|
|
RISPERDALCONSTA(0.5MG)25mg SYR
|
Facility
|
OP
|
$30.09
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
636T0058
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$3.91 |
Max. Negotiated Rate |
$28.89 |
Rate for Payer: Aetna Commercial |
$23.17
|
Rate for Payer: Anthem Medicaid |
$10.35
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$12.15
|
Rate for Payer: Anthem POS/PPO/Traditional |
$23.47
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.01
|
Rate for Payer: CareSource Just4Me Medicare |
$16.40
|
Rate for Payer: Cash Price |
$15.04
|
Rate for Payer: Cash Price |
$15.04
|
Rate for Payer: Cigna Commercial |
$24.97
|
Rate for Payer: First Health Commercial |
$28.59
|
Rate for Payer: Humana Commercial |
$25.58
|
Rate for Payer: Humana KY Medicaid |
$10.35
|
Rate for Payer: Humana Medicare Advantage |
$12.15
|
Rate for Payer: Kentucky WC Medicaid |
$10.45
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$24.67
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.21
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$14.58
|
Rate for Payer: Molina Healthcare Medicaid |
$10.56
|
Rate for Payer: Ohio Health Choice Commercial |
$26.48
|
Rate for Payer: Ohio Health Group HMO |
$22.57
|
Rate for Payer: Ohio Health Group PPO Differential |
$6.02
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.33
|
Rate for Payer: PHCS Commercial |
$28.89
|
Rate for Payer: United Healthcare All Payer |
$26.48
|
|
RISPERDALCONSTA(0.5MG)25mg SYR
|
Facility
|
OP
|
$3,349.35
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
25002348
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$12.15 |
Max. Negotiated Rate |
$3,215.38 |
Rate for Payer: Aetna Commercial |
$2,579.00
|
Rate for Payer: Anthem Medicaid |
$1,151.84
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$12.15
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,612.49
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.01
|
Rate for Payer: CareSource Just4Me Medicare |
$16.40
|
Rate for Payer: Cash Price |
$1,674.67
|
Rate for Payer: Cash Price |
$1,674.67
|
Rate for Payer: Cigna Commercial |
$2,779.96
|
Rate for Payer: First Health Commercial |
$3,181.88
|
Rate for Payer: Humana Commercial |
$2,846.95
|
Rate for Payer: Humana KY Medicaid |
$1,151.84
|
Rate for Payer: Humana Medicare Advantage |
$12.15
|
Rate for Payer: Kentucky WC Medicaid |
$1,163.56
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,746.47
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,471.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$14.58
|
Rate for Payer: Molina Healthcare Medicaid |
$1,174.95
|
Rate for Payer: Ohio Health Choice Commercial |
$2,947.43
|
Rate for Payer: Ohio Health Group HMO |
$2,512.01
|
Rate for Payer: Ohio Health Group PPO Differential |
$669.87
|
Rate for Payer: Ohio Health Group PPO No Differential |
$435.42
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,038.30
|
Rate for Payer: PHCS Commercial |
$3,215.38
|
Rate for Payer: United Healthcare All Payer |
$2,947.43
|
|
RISPERDALCONSTA(0.5MG)25mg SYR
|
Professional
|
Both
|
$30.09
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
63600058
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$10.53 |
Max. Negotiated Rate |
$30.09 |
Rate for Payer: Aetna Commercial |
$15.10
|
Rate for Payer: Buckeye Medicare Advantage |
$30.09
|
Rate for Payer: Cash Price |
$15.04
|
Rate for Payer: Cash Price |
$15.04
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.93
|
Rate for Payer: Multiplan PHCS |
$18.05
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$21.06
|
Rate for Payer: UHCCP Medicaid |
$10.53
|
|
RISPERDALCONSTA(0.5MG)25mg SYR
|
Facility
|
OP
|
$30.09
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
63600058
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$3.91 |
Max. Negotiated Rate |
$28.89 |
Rate for Payer: Aetna Commercial |
$23.17
|
Rate for Payer: Anthem Medicaid |
$10.35
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$12.15
|
Rate for Payer: Anthem POS/PPO/Traditional |
$23.47
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.01
|
Rate for Payer: CareSource Just4Me Medicare |
$16.40
|
Rate for Payer: Cash Price |
$15.04
|
Rate for Payer: Cash Price |
$15.04
|
Rate for Payer: Cigna Commercial |
$24.97
|
Rate for Payer: First Health Commercial |
$28.59
|
Rate for Payer: Humana Commercial |
$25.58
|
Rate for Payer: Humana KY Medicaid |
$10.35
|
Rate for Payer: Humana Medicare Advantage |
$12.15
|
Rate for Payer: Kentucky WC Medicaid |
$10.45
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$24.67
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.21
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$14.58
|
Rate for Payer: Molina Healthcare Medicaid |
$10.56
|
Rate for Payer: Ohio Health Choice Commercial |
$26.48
|
Rate for Payer: Ohio Health Group HMO |
$22.57
|
Rate for Payer: Ohio Health Group PPO Differential |
$6.02
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.33
|
Rate for Payer: PHCS Commercial |
$28.89
|
Rate for Payer: United Healthcare All Payer |
$26.48
|
|
RISPERDALCONSTA(0.5MG)25mg SYR
|
Facility
|
IP
|
$30.09
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
636T0058
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$3.91 |
Max. Negotiated Rate |
$28.89 |
Rate for Payer: Aetna Commercial |
$23.17
|
Rate for Payer: Anthem POS/PPO/Traditional |
$23.47
|
Rate for Payer: Cash Price |
$15.04
|
Rate for Payer: Cigna Commercial |
$24.97
|
Rate for Payer: First Health Commercial |
$28.59
|
Rate for Payer: Humana Commercial |
$25.58
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$24.67
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.21
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$9.03
|
Rate for Payer: Ohio Health Choice Commercial |
$26.48
|
Rate for Payer: Ohio Health Group HMO |
$22.57
|
Rate for Payer: Ohio Health Group PPO Differential |
$6.02
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.33
|
Rate for Payer: PHCS Commercial |
$28.89
|
Rate for Payer: United Healthcare All Payer |
$26.48
|
|
RISPERDALCONSTA(0.5MG)25mg SYR
|
Facility
|
IP
|
$30.09
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
63600058
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$3.91 |
Max. Negotiated Rate |
$28.89 |
Rate for Payer: Aetna Commercial |
$23.17
|
Rate for Payer: Anthem POS/PPO/Traditional |
$23.47
|
Rate for Payer: Cash Price |
$15.04
|
Rate for Payer: Cigna Commercial |
$24.97
|
Rate for Payer: First Health Commercial |
$28.59
|
Rate for Payer: Humana Commercial |
$25.58
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$24.67
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.21
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$9.03
|
Rate for Payer: Ohio Health Choice Commercial |
$26.48
|
Rate for Payer: Ohio Health Group HMO |
$22.57
|
Rate for Payer: Ohio Health Group PPO Differential |
$6.02
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.33
|
Rate for Payer: PHCS Commercial |
$28.89
|
Rate for Payer: United Healthcare All Payer |
$26.48
|
|
RISPERDALCONSTA(0.5mg)37.5MGER
|
Facility
|
IP
|
$28.67
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
636T0218
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$3.73 |
Max. Negotiated Rate |
$27.52 |
Rate for Payer: Aetna Commercial |
$22.08
|
Rate for Payer: Anthem POS/PPO/Traditional |
$22.36
|
Rate for Payer: Cash Price |
$14.34
|
Rate for Payer: Cigna Commercial |
$23.80
|
Rate for Payer: First Health Commercial |
$27.24
|
Rate for Payer: Humana Commercial |
$24.37
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$23.51
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.16
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$8.60
|
Rate for Payer: Ohio Health Choice Commercial |
$25.23
|
Rate for Payer: Ohio Health Group HMO |
$21.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$5.73
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3.73
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.89
|
Rate for Payer: PHCS Commercial |
$27.52
|
Rate for Payer: United Healthcare All Payer |
$25.23
|
|
RISPERDALCONSTA(0.5mg)37.5MGER
|
Facility
|
IP
|
$28.67
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
63600218
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$3.73 |
Max. Negotiated Rate |
$27.52 |
Rate for Payer: Aetna Commercial |
$22.08
|
Rate for Payer: Anthem POS/PPO/Traditional |
$22.36
|
Rate for Payer: Cash Price |
$14.34
|
Rate for Payer: Cigna Commercial |
$23.80
|
Rate for Payer: First Health Commercial |
$27.24
|
Rate for Payer: Humana Commercial |
$24.37
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$23.51
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.16
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$8.60
|
Rate for Payer: Ohio Health Choice Commercial |
$25.23
|
Rate for Payer: Ohio Health Group HMO |
$21.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$5.73
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3.73
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.89
|
Rate for Payer: PHCS Commercial |
$27.52
|
Rate for Payer: United Healthcare All Payer |
$25.23
|
|
RISPERDALCONSTA(0.5mg)37.5MGER
|
Facility
|
OP
|
$28.67
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
636T0218
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$3.73 |
Max. Negotiated Rate |
$27.52 |
Rate for Payer: Aetna Commercial |
$22.08
|
Rate for Payer: Anthem Medicaid |
$9.86
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$12.15
|
Rate for Payer: Anthem POS/PPO/Traditional |
$22.36
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.01
|
Rate for Payer: CareSource Just4Me Medicare |
$16.40
|
Rate for Payer: Cash Price |
$14.34
|
Rate for Payer: Cash Price |
$14.34
|
Rate for Payer: Cigna Commercial |
$23.80
|
Rate for Payer: First Health Commercial |
$27.24
|
Rate for Payer: Humana Commercial |
$24.37
|
Rate for Payer: Humana KY Medicaid |
$9.86
|
Rate for Payer: Humana Medicare Advantage |
$12.15
|
Rate for Payer: Kentucky WC Medicaid |
$9.96
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$23.51
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.16
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$14.58
|
Rate for Payer: Molina Healthcare Medicaid |
$10.06
|
Rate for Payer: Ohio Health Choice Commercial |
$25.23
|
Rate for Payer: Ohio Health Group HMO |
$21.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$5.73
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3.73
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.89
|
Rate for Payer: PHCS Commercial |
$27.52
|
Rate for Payer: United Healthcare All Payer |
$25.23
|
|
RISPERDALCONSTA(0.5mg)37.5MGER
|
Professional
|
Both
|
$28.67
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
63600218
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$10.03 |
Max. Negotiated Rate |
$28.67 |
Rate for Payer: Aetna Commercial |
$15.10
|
Rate for Payer: Buckeye Medicare Advantage |
$28.67
|
Rate for Payer: Cash Price |
$14.34
|
Rate for Payer: Cash Price |
$14.34
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.93
|
Rate for Payer: Multiplan PHCS |
$17.20
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$20.07
|
Rate for Payer: UHCCP Medicaid |
$10.03
|
|
RISPERDALCONSTA(0.5mg)37.5MGER
|
Facility
|
OP
|
$28.67
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
63600218
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$3.73 |
Max. Negotiated Rate |
$27.52 |
Rate for Payer: Aetna Commercial |
$22.08
|
Rate for Payer: Anthem Medicaid |
$9.86
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$12.15
|
Rate for Payer: Anthem POS/PPO/Traditional |
$22.36
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.01
|
Rate for Payer: CareSource Just4Me Medicare |
$16.40
|
Rate for Payer: Cash Price |
$14.34
|
Rate for Payer: Cash Price |
$14.34
|
Rate for Payer: Cigna Commercial |
$23.80
|
Rate for Payer: First Health Commercial |
$27.24
|
Rate for Payer: Humana Commercial |
$24.37
|
Rate for Payer: Humana KY Medicaid |
$9.86
|
Rate for Payer: Humana Medicare Advantage |
$12.15
|
Rate for Payer: Kentucky WC Medicaid |
$9.96
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$23.51
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.16
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$14.58
|
Rate for Payer: Molina Healthcare Medicaid |
$10.06
|
Rate for Payer: Ohio Health Choice Commercial |
$25.23
|
Rate for Payer: Ohio Health Group HMO |
$21.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$5.73
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3.73
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.89
|
Rate for Payer: PHCS Commercial |
$27.52
|
Rate for Payer: United Healthcare All Payer |
$25.23
|
|
RISPERDALCONSTA 0.5mg(50mgSyr)
|
Professional
|
Both
|
$64.53
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
63600224
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$14.93 |
Max. Negotiated Rate |
$64.53 |
Rate for Payer: Aetna Commercial |
$15.10
|
Rate for Payer: Buckeye Medicare Advantage |
$64.53
|
Rate for Payer: Cash Price |
$32.26
|
Rate for Payer: Cash Price |
$32.26
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.93
|
Rate for Payer: Multiplan PHCS |
$38.72
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.17
|
Rate for Payer: UHCCP Medicaid |
$22.59
|
|
RISPERDALCONSTA 0.5mg(50mgSyr)
|
Facility
|
OP
|
$64.53
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
63600224
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$8.39 |
Max. Negotiated Rate |
$61.95 |
Rate for Payer: Aetna Commercial |
$49.69
|
Rate for Payer: Anthem Medicaid |
$22.19
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$12.15
|
Rate for Payer: Anthem POS/PPO/Traditional |
$50.33
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.01
|
Rate for Payer: CareSource Just4Me Medicare |
$16.40
|
Rate for Payer: Cash Price |
$32.26
|
Rate for Payer: Cash Price |
$32.26
|
Rate for Payer: Cigna Commercial |
$53.56
|
Rate for Payer: First Health Commercial |
$61.30
|
Rate for Payer: Humana Commercial |
$54.85
|
Rate for Payer: Humana KY Medicaid |
$22.19
|
Rate for Payer: Humana Medicare Advantage |
$12.15
|
Rate for Payer: Kentucky WC Medicaid |
$22.42
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$52.91
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$14.58
|
Rate for Payer: Molina Healthcare Medicaid |
$22.64
|
Rate for Payer: Ohio Health Choice Commercial |
$56.79
|
Rate for Payer: Ohio Health Group HMO |
$48.40
|
Rate for Payer: Ohio Health Group PPO Differential |
$12.91
|
Rate for Payer: Ohio Health Group PPO No Differential |
$8.39
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.00
|
Rate for Payer: PHCS Commercial |
$61.95
|
Rate for Payer: United Healthcare All Payer |
$56.79
|
|
RISPERDALCONSTA 0.5mg(50mgSyr)
|
Facility
|
OP
|
$64.53
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
636T0224
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$8.39 |
Max. Negotiated Rate |
$61.95 |
Rate for Payer: Aetna Commercial |
$49.69
|
Rate for Payer: Anthem Medicaid |
$22.19
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$12.15
|
Rate for Payer: Anthem POS/PPO/Traditional |
$50.33
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.01
|
Rate for Payer: CareSource Just4Me Medicare |
$16.40
|
Rate for Payer: Cash Price |
$32.26
|
Rate for Payer: Cash Price |
$32.26
|
Rate for Payer: Cigna Commercial |
$53.56
|
Rate for Payer: First Health Commercial |
$61.30
|
Rate for Payer: Humana Commercial |
$54.85
|
Rate for Payer: Humana KY Medicaid |
$22.19
|
Rate for Payer: Humana Medicare Advantage |
$12.15
|
Rate for Payer: Kentucky WC Medicaid |
$22.42
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$52.91
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$14.58
|
Rate for Payer: Molina Healthcare Medicaid |
$22.64
|
Rate for Payer: Ohio Health Choice Commercial |
$56.79
|
Rate for Payer: Ohio Health Group HMO |
$48.40
|
Rate for Payer: Ohio Health Group PPO Differential |
$12.91
|
Rate for Payer: Ohio Health Group PPO No Differential |
$8.39
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.00
|
Rate for Payer: PHCS Commercial |
$61.95
|
Rate for Payer: United Healthcare All Payer |
$56.79
|
|
RISPERDALCONSTA 0.5mg(50mgSyr)
|
Facility
|
IP
|
$6,699.19
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
25004437
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$870.89 |
Max. Negotiated Rate |
$6,431.22 |
Rate for Payer: Aetna Commercial |
$5,158.38
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,225.37
|
Rate for Payer: Cash Price |
$3,349.59
|
Rate for Payer: Cigna Commercial |
$5,560.33
|
Rate for Payer: First Health Commercial |
$6,364.23
|
Rate for Payer: Humana Commercial |
$5,694.31
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,493.34
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,944.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,009.76
|
Rate for Payer: Ohio Health Choice Commercial |
$5,895.29
|
Rate for Payer: Ohio Health Group HMO |
$5,024.39
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,339.84
|
Rate for Payer: Ohio Health Group PPO No Differential |
$870.89
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,076.75
|
Rate for Payer: PHCS Commercial |
$6,431.22
|
Rate for Payer: United Healthcare All Payer |
$5,895.29
|
|
RISPERDALCONSTA 0.5mg(50mgSyr)
|
Facility
|
OP
|
$6,699.19
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
25004437
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$12.15 |
Max. Negotiated Rate |
$6,431.22 |
Rate for Payer: Aetna Commercial |
$5,158.38
|
Rate for Payer: Anthem Medicaid |
$2,303.85
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$12.15
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,225.37
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.01
|
Rate for Payer: CareSource Just4Me Medicare |
$16.40
|
Rate for Payer: Cash Price |
$3,349.59
|
Rate for Payer: Cash Price |
$3,349.59
|
Rate for Payer: Cigna Commercial |
$5,560.33
|
Rate for Payer: First Health Commercial |
$6,364.23
|
Rate for Payer: Humana Commercial |
$5,694.31
|
Rate for Payer: Humana KY Medicaid |
$2,303.85
|
Rate for Payer: Humana Medicare Advantage |
$12.15
|
Rate for Payer: Kentucky WC Medicaid |
$2,327.30
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,493.34
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,944.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$14.58
|
Rate for Payer: Molina Healthcare Medicaid |
$2,350.08
|
Rate for Payer: Ohio Health Choice Commercial |
$5,895.29
|
Rate for Payer: Ohio Health Group HMO |
$5,024.39
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,339.84
|
Rate for Payer: Ohio Health Group PPO No Differential |
$870.89
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,076.75
|
Rate for Payer: PHCS Commercial |
$6,431.22
|
Rate for Payer: United Healthcare All Payer |
$5,895.29
|
|
RISPERDALCONSTA 0.5mg(50mgSyr)
|
Facility
|
IP
|
$64.53
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
636T0224
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$8.39 |
Max. Negotiated Rate |
$61.95 |
Rate for Payer: Aetna Commercial |
$49.69
|
Rate for Payer: Anthem POS/PPO/Traditional |
$50.33
|
Rate for Payer: Cash Price |
$32.26
|
Rate for Payer: Cigna Commercial |
$53.56
|
Rate for Payer: First Health Commercial |
$61.30
|
Rate for Payer: Humana Commercial |
$54.85
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$52.91
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$19.36
|
Rate for Payer: Ohio Health Choice Commercial |
$56.79
|
Rate for Payer: Ohio Health Group HMO |
$48.40
|
Rate for Payer: Ohio Health Group PPO Differential |
$12.91
|
Rate for Payer: Ohio Health Group PPO No Differential |
$8.39
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.00
|
Rate for Payer: PHCS Commercial |
$61.95
|
Rate for Payer: United Healthcare All Payer |
$56.79
|
|
RISPERDALCONSTA 0.5mg(50mgSyr)
|
Facility
|
IP
|
$64.53
|
|
Service Code
|
HCPCS J2794
|
Hospital Charge Code |
63600224
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$8.39 |
Max. Negotiated Rate |
$61.95 |
Rate for Payer: Aetna Commercial |
$49.69
|
Rate for Payer: Anthem POS/PPO/Traditional |
$50.33
|
Rate for Payer: Cash Price |
$32.26
|
Rate for Payer: Cigna Commercial |
$53.56
|
Rate for Payer: First Health Commercial |
$61.30
|
Rate for Payer: Humana Commercial |
$54.85
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$52.91
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$19.36
|
Rate for Payer: Ohio Health Choice Commercial |
$56.79
|
Rate for Payer: Ohio Health Group HMO |
$48.40
|
Rate for Payer: Ohio Health Group PPO Differential |
$12.91
|
Rate for Payer: Ohio Health Group PPO No Differential |
$8.39
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.00
|
Rate for Payer: PHCS Commercial |
$61.95
|
Rate for Payer: United Healthcare All Payer |
$56.79
|
|