What is the standard insurance baseline for HCPCS J2426?

The standard insurance baseline reimbursement rate is $0.01. This represents the customary allowable amount established across standard fee schedules.

Home/Procedures/Injection Paliperidone Palmitate Extended Release Invega Sustenna 1 Mg

HCPCS J2426Medical Service

Injection Paliperidone Palmitate Extended Release Invega Sustenna 1 Mg

Q: What do doctors typically charge for Injection Paliperidone Palmitate Extended Release Invega Sustenna 1 Mg?

The nationwide median physician charge for Injection Paliperidone Palmitate Extended Release Invega Sustenna 1 Mg (HCPCS J2426) is $0.01. Doctor billed charges vary based on geographic region, setting, and overhead.

Injection, paliperidone palmitate extended release (invega sustenna), 1 mg. Clinical pricing breakdown and utilization metrics across 13 practicing doctors nationwide.

$0.01

Peer Median Charge

Gross billed rate

$0.01

Standard Baseline

Customary allowable

1.0x

National Markup

Charge vs baseline

Active Physicians

Billing this code

Planning care or already received a bill for CPT J2426?Calculate total facility bundle costs or generate an assertive dispute settlement offer.

Calculate Bundled Cost →Dispute an Inflated Bill 🧾

Understanding This Medical Fee

Gross Charge vs Negotiated Payment: The median physician charge for this service is $0.01. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $0.01 baseline.

Self-Pay & Uninsured Guidance: If you are paying without insurance or out-of-network, request a prompt-pay cash discount. Most medical practices are willing to settle self-pay bills near the customary baseline rate rather than the full gross charge.

Key Questions for Your Doctor's Billing Office:

"Does Dr. [Name] participate in my specific insurance plan network?"
"What is the total self-pay or cash rate for code J2426 if paid upfront?"
"Are there separate facility, anesthesia, or pathology fees associated with this procedure?"