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Facility | Network | Location | Facility Name | Network | City | State | URL | Service Type (INTERNAL) | Service Type | Age | Network Options | Performance Network | Case Rate | Inlier Days | Outpatient Transplant | Outlier Per Diem | Lesser of provision | Pre-/Post-Transplant Services | Harvesting Charges | Registry Search Fees | Organ Acquisition Charges | Implantable Devices | Stoploss/Threshold | Pre Transplant Phase | Transplant Phase | Post Transplant Phase | PPI: 1 Year Survival | PPI: Interlink's Performance Score | Key Outcome Data | Cost Considerations: Average | Cost Considerations: deaths | Cost Considerations: Waitlist | Facility ID | Geocode Latitude | Geocode Longitude | |
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University of Alabama Hospital | Transplant | Birmingham | AL | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $124,355 | N/A | N/A | N/A | 90% of Billed Charges | 90% of Billed Charges | Included in Case Rate | N/A | If Billed Charges Exceed $165,750, Payment Shall be the Case Rate Plus 85% of the Excess Charges | Begins at Evaluation | Begins on the Day of Transplant Admission and Ends at Discharge | Ends 365 Days from Discharge | 33.5314448 | -86.9902206 | |||||||||||||||
University of Alabama Hospital | Transplant | Birmingham | AL | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | Sibling: $150,195 | Family: $176,673 | N/A | N/A | N/A | 90% of Billed Charges | 90% of Billed Charges | Included in Case Rate | N/A | If Billed Charges Exceed $200,260 (Sibling) or $235,578 (Other Family), Then Payment Shall be the Case Rate Plus 85% of the Excess Charges | Begins at Evaluation | Begins on the Day of Transplant Admission and Ends at Discharge | Ends 365 Days from Discharge | 33.5314448 | -86.9902206 | |||||||||||||||
University of Alabama Hospital | Transplant | Birmingham | AL | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | $208,675 | N/A | N/A | N/A | 90% of Billed Charges | 90% of Billed Charges | NMDP and HLA Typing Charges Shall be Reimbursed at 90% of Billed Charges | NMDP and HLA Typing Charges Shall be Reimbursed at 90% of Billed Charges | If Billed Charges Exceed $278,248, Payment Shall be the Case Rate Plus 85% of the Excess Charges | Begins at Evaluation | Begins on the Day of Transplant Admission and Ends at Discharge | Ends 365 Days from Discharge | 33.5314448 | -86.9902206 | |||||||||||||||
University of Alabama Hospital | Transplant | Birmingham | AL | Heart | Heart | Adult | Programs of Excellence | PerformanceELITE | $130,237 | 18 | 85% of Billed Charges | 85% of Billed Charges | 90% of Billed Charges | Included in Case Rate | N/A | In no Event will less than 75% of Billed Charges be Paid | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 33.5314448 | -86.9902206 | |||||||||||||||
University of Alabama Hospital | Transplant | Birmingham | AL | Heart/Lung | Heart/Lung | Adult | Member's Choice | 85% of Billed Charges | N/A | 85% of Billed Charges | N/A | 90% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 33.5314448 | -86.9902206 | ||||||||||||||||
University of Alabama Hospital | Transplant | Birmingham | AL | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | $57,401 | 12 | 85% of Billed Charges | 85% of Billed Charges | 90% of Billed Charges | Included in Case Rate | N/A | In no Event will less than 75% of Billed Charges be Paid | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 33.5314448 | -86.9902206 | |||||||||||||||
University of Alabama Hospital | Transplant | Birmingham | AL | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceSELECT | $83,619 | 16 | 85% of Billed Charges | 85% of Billed Charges | 90% of Billed Charges | Included in Case Rate | N/A | In no Event will less than 75% of Billed Charges be Paid | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 33.5314448 | -86.9902206 | |||||||||||||||
University of Alabama Hospital | Transplant | Birmingham | AL | Liver | Liver | Adult | Member's Choice | $160,208 | 23 | 85% of Billed Charges | 85% of Billed Charges | 90% of Billed Charges | Included in Case Rate | N/A | In no Event will less than 75% of Billed Charges be Paid | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 33.5314448 | -86.9902206 | ||||||||||||||||
University of Alabama Hospital | Transplant | Birmingham | AL | Lung | Lung | Adult | Member's Choice | Bilateral: $120,020 | Single: $107,024 | 20 | 85% of Billed Charges | 85% of Billed Charges | 90% of Billed Charges | Included in Case Rate | N/A | In no Event will less than 75% of Billed Charges be Paid | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 33.5314448 | -86.9902206 | ||||||||||||||||
University of Alabama Hospital | Transplant | Birmingham | AL | Pancreas | Pancreas | Adult | Member's Choice | $70,529 | 14 | 85% of Billed Charges | 85% of Billed Charges | 90% of Billed Charges | Included in Case Rate | N/A | In no Event will less than 75% of Billed Charges be Paid | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 33.5314448 | -86.9902206 | ||||||||||||||||
University of Alabama Hospital | Transplant | Birmingham | AL | Heart | Heart | Pediatric | Member's Choice | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | 33.5314448 | -86.9902206 | ||||||||||||||||
University of Alabama Hospital | Transplant | Birmingham | AL | Heart/Lung | Heart/Lung | Pediatric | Member's Choice | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | 33.5314448 | -86.9902206 | ||||||||||||||||
University of Alabama Hospital | Transplant | Birmingham | AL | Kidney | Kidney | Pediatric | Member's Choice | $57,401 | 12 | 85% of Billed Charges | 85% of Billed Charges | 90% of Billed Charges | Included in Case Rate | N/A | N/A | N/A | N/A | N/A | 33.5314448 | -86.9902206 | ||||||||||||||||
University of Alabama Hospital | Transplant | Birmingham | AL | Liver | Liver | Pediatric | Member's Choice | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | 33.5314448 | -86.9902206 | ||||||||||||||||
University of Alabama Hospital | Transplant | Birmingham | AL | Lung | Lung | Pediatric | Member's Choice | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | 33.5314448 | -86.9902206 | ||||||||||||||||
University of Arkansas for Medical Sciences (UAMS) | Transplant | Little Rock | AR | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $75,000 | 90 | Begins on the First Day of Ablative Therapy and Ends at Discharge | N/A | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | If Billed Charges Exceed $131,250, Payment will be the Transplant Case Rate Plus 60% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when the Inlier period has Expired | Ends 365 Days from the End of the Inlier Days | 34.724126 | -92.4079673 | |||||||||||||||
University of Arkansas for Medical Sciences (UAMS) | Transplant | Little Rock | AR | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | $150,000 | 90 | Begins on the First Day of Ablative Therapy and Ends at Discharge | N/A | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | If Billed Charges Exceed $262,500, Payment will be the Transplant Case Rate Plus 60% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when the Inlier period has Expired | Ends 365 Days from the End of the Inlier Days | 34.724126 | -92.4079673 | |||||||||||||||
University of Arkansas for Medical Sciences (UAMS) | Transplant | Little Rock | AR | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | $125,000 | 90 | Begins on the First Day of Ablative Therapy and Ends at Discharge | N/A | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | If Billed Charges Exceed $218,750, Payment will be the Transplant Case Rate Plus 60% of the Excess charge | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when the Inlier period has Expired | Ends 365 Days from the End of the Inlier Days | 34.724126 | -92.4079673 | |||||||||||||||
University of Arkansas for Medical Sciences (UAMS) | Transplant | Little Rock | AR | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Adult | Member's Choice | 1st Infusion: $75,000 | 2nd Infusion: $56,250 | 1st Infusion: 30 | 2nd Infusion: 60 | Begins on the First Day of Ablative Therapy and Ends at Discharge | N/A | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 1st infustion $131,250 Then 60% of Charges 2nd infustion $98,438 Then 60% of Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when the Inlier period has Expired | Ends 365 Days from the End of the Inlier Days | 34.724126 | -92.4079673 | |||||||||||||||
University of Arkansas for Medical Sciences (UAMS) | Transplant | Little Rock | AR | Blood/Marrow (Tandem Auto to Allo) | Tandem Auto to Allo | Adult | Member's Choice | 1st Infusion: $75,000 | 2nd Infusion: $150,000 | 1st Infusion: 30 | 2nd Infusion: 60 | Begins on the First Day of Ablative Therapy and Ends at Discharge | N/A | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 1st infustion $131,250 Then 60% of Charges 2nd infustion $262,500 Then 60% of Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when the Inlier period has Expired | Ends 365 Days from the End of the Inlier Days | 34.724126 | -92.4079673 | |||||||||||||||
University of Arkansas for Medical Sciences (UAMS) | Transplant | Little Rock | AR | Kidney | Kidney | Adult | Programs of Excellence | PerformanceELITE | $70,000 | 14 | $2,500 Med/Surg | 2,500 ICU/CCU | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | 55% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One (1) Year from the End of the Transplant Phase | Ends 365 Days from the End of the Inlier Days and any Applicable Outlier Days | 34.724126 | -92.4079673 | |||||||||||||||
University of Arkansas for Medical Sciences (UAMS) | Transplant | Little Rock | AR | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $100,000 | 20 | $2,500 Med/Surg | 2,500 ICU/CCU | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | 55% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One (1) Year from the End of the Transplant Phase | Ends 365 Days from the End of the Inlier Days and any Applicable Outlier Days | 34.724126 | -92.4079673 | ||||||||||||||||
University of Arkansas for Medical Sciences (UAMS) | Transplant | Little Rock | AR | Liver | Liver | Adult | Programs of Excellence | PerformanceSELECT | $150,000 | 30 | $2,500 Med/Surg | 2,500 ICU/CCU | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | 55% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One (1) Year from the End of the Transplant Phase | Ends 365 Days from the End of the Inlier Days and any Applicable Outlier Days | 34.724126 | -92.4079673 | |||||||||||||||
University of Arkansas for Medical Sciences (UAMS) | Transplant | Little Rock | AR | Pancreas | Pancreas | Adult | Member's Choice | $75,000 | 14 | $2,500 Med/Surg | 2,500 ICU/CCU | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | 55% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One (1) Year from the End of the Transplant Phase | Ends 365 Days from the End of the Inlier Days and any Applicable Outlier Days | 34.724126 | -92.4079673 | ||||||||||||||||
Mayo Clinic Hospital (Arizona) | Transplant | Phoenix | AZ | Heart | Heart | Adult | Programs of Excellence | PerformanceELITE | $98,000 | N/A | N/A | 95% of Billed Charges | Hospital: 90% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant, Unless Patient is Admitted One (1) Day Prior to Transplant then the Transplant Phase Begins at Admission and Ends at Discharge | Ends 365 Days from Discharge | 33.6056711 | -112.4052341 | |||||||||||||||
Mayo Clinic Hospital (Arizona) | Transplant | Phoenix | AZ | Kidney | Kidney | Adult | Programs of Excellence | PerformanceELITE | Cadaveric Donor: $48,000 | Living Donor: $62,000 | N/A | N/A | 95% of Billed Charges | Hospital: 90% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant, Unless Patient is Admitted One (1) Day Prior to Transplant then the Transplant Phase Begins at Admission and Ends at Discharge | Ends 365 Days from Discharge | 33.6056711 | -112.4052341 | |||||||||||||||
Mayo Clinic Hospital (Arizona) | Transplant | Phoenix | AZ | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceSELECT | $98,000 | N/A | N/A | 95% of Billed Charges | Hospital: 90% of Billed Charges |Professional: 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant, Unless Patient is Admitted One (1) Day Prior to Transplant then the Transplant Phase Begins at Admission and Ends at Discharge | Ends 365 Days from Discharge | 33.6056711 | -112.4052341 | |||||||||||||||
Mayo Clinic Hospital (Arizona) | Transplant | Phoenix | AZ | Liver | Liver | Adult | Programs of Excellence | PerformanceELITE | Cadaveric Donor: $128,000 | Living Donor: $158,000 | N/A | N/A | 95% of Billed Charges | Hospital: 90% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant, Unless Patient is Admitted One (1) Day Prior to Transplant then the Transplant Phase Begins at Admission and Ends at Discharge | Ends 365 Days from Discharge | 33.6056711 | -112.4052341 | |||||||||||||||
Mayo Clinic Hospital (Arizona) | Transplant | Phoenix | AZ | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceELITE | $69,000 | 50 | N/A | 95% of Billed Charges | Hospital: 90% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate During Inlier Day's Period; Reimbused at Pre-Transplant Rate if Provided Prior to Inlier Period | Included in Case Rate | 70% of Billed Charges | Begins at Evaluation | Begins 10 Days Prior to the initial Infusion Date and Ends when the Inlier Days have Expired | Ends 365 Days from Date of Initial Infusion | 33.6056711 | -112.4052341 | |||||||||||||||
Mayo Clinic Hospital (Arizona) | Transplant | Phoenix | AZ | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceELITE | $138,000 | 100 | NA | 95% of Billed Charges | Hospital: 90% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate During Inlier Day's Period; Reimbused at Pre-Transplant Rate if Provided Prior to Inlier Period | Included in Case Rate | 70% of Billed Charges | Begins at Evaluation | Begins 10 Days Prior to the initial Infusion Date and Ends when the Inlier Days have Expired | Ends 365 Days from Date of Initial Infusion | 33.6056711 | -112.4052341 | |||||||||||||||
Mayo Clinic Hospital (Arizona) | Transplant | Phoenix | AZ | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceELITE | Matched: $118000 | Mismatched: $138,000 | 100 | NA | 95% of Billed Charges | Hospital: 90% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate During Inlier Day's Period; Reimbused at Pre-Transplant Rate if Provided Prior to Inlier Period | Included in Case Rate | 70% of Billed Charges | Begins at Evaluation | Begins 10 Days Prior to the initial Infusion Date and Ends when the Inlier Days have Expired | Ends 365 Days from Date of Initial Infusion | 33.6056711 | -112.4052341 | |||||||||||||||
Phoenix Children's Hospital | Transplant | Phoenix | AZ | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $180,000 | 30 | N/A | $6,000 Med/Surg | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | Any Charges that Exceed $350,000 Shall be Reimbursed at 65%, in Addition to the Case Rate and any Applicable Per Diems | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from the End of the Inlier Days and any Applicable Outlier Days | 33.6056711 | -112.4052341 | |||||||||||||||
Phoenix Children's Hospital | Transplant | Phoenix | AZ | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $200,000 | 35 | N/A | $6,000 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | Any Charges that Exceed $380,000 Shall be Reimbursed at 65%, in Addition to the Case Rate and any Applicable Per Diems | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from the End of the Inlier Days and any Applicable Outlier Days | 33.6056711 | -112.4052341 | |||||||||||||||
Phoenix Children's Hospital | Transplant | Phoenix | AZ | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $150,000 | 25 | N/A | $6,000 Med/Surg | $6,000 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | Any Charges that Exceed $280,000 Shall be Reimbursed at 65%, in Addition to the Case Rate and any Applicable Per Diems | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from the End of the Inlier Days and any Applicable Outlier Days | 33.6056711 | -112.4052341 | |||||||||||||||
Phoenix Children's Hospital | Transplant | Phoenix | AZ | Heart | Heart | Pediatric | Programs of Excellence | $300,000 | 15 | $6,000 Med/Surg | $6,000 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost, Plus 10% | Any Charges that Exceed $520,000 Shall be Reimbursed at 65%, in Addition to the Case Rate and any Applicable Per Diems | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends Upon the Expiration of the Inlier Days or Discharge, Whichever is Earlier | Ends 365 Days from Discharge | 33.6056711 | -112.4052341 | ||||||||||||||||
Phoenix Children's Hospital | Transplant | Phoenix | AZ | Kidney | Kidney | Pediatric | Programs of Excellence | Cadaveric Donor: $130,000 | Living Donor: $140,000 | Cadaveric: 9 |Living: 10 | $6,000 Med/Surg | $6,000 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost, Plus 10% | Any Charges that Exceed $240,000 (Cadaveric) or $260,000 (Living) Shall be Reimbursed at 65%, in Addition to the Case Rate and any Applicable Per Diems | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends Upon the Expiration of the Inlier Days or Discharge, Whichever is Earlier | Ends 365 Days from Discharge | 33.6056711 | -112.4052341 | ||||||||||||||||
Phoenix Children's Hospital | Transplant | Phoenix | AZ | Liver | Liver | Pediatric | Member's Choice | $225,000 | 30 | $6,000 Med/Surg | $6,000 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost, Plus 10% | Any Charges that Exceed $420,000 Shall be Reimbursed at 65%, in Addition to the Case Rate and any Applicable Per Diems | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends Upon the Expiration of the Inlier Days or Discharge, Whichever is Earlier | Ends 365 Days from Discharge | 33.6056711 | -112.4052341 | ||||||||||||||||
St Joseph's Hospital and Medical Center | Transplant | Phoenix | AZ | Kidney | Kidney | Adult | Member's Choice | Hospital: $85,000 | Professonal: $15,000 | 7 | Hospital: $4,500 | Professional: $950 | 90% of Billed Charges | Hospital Inpatient: $4,500 Per Diem | Hospital Outpatient: 70% of Billed Charges | Professional Inpatient: $950 Per Diem | Professional Outpatient: 70% of Billed Charges | Acute Rehab: 70% of Billed Charges | Included in Case Rate | Reimbursed at 120% of Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 33.6056711 | -112.4052341 | ||||||||||||||||
St Joseph's Hospital and Medical Center | Transplant | Phoenix | AZ | Liver | Liver | Adult | Member's Choice | Hospital: $190,000 | Professonal: $33,000 | 20 | Hospital: $4,500 | Professional: $950 | 90% of Billed Charges | Hospital Inpatient: $4,500 Per Diem | Hospital Outpatient: 70% of Billed Charges | Professional Inpatient: $950 Per Diem |Professional Outpatient: 70% of Billed Charges | Acute Rehab: 70% of Billed Charges | Included in Case Rate | Reimbursed at 120% of Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 33.6056711 | -112.4052341 | ||||||||||||||||
St Joseph's Hospital and Medical Center | Transplant | Phoenix | AZ | Lung | Lung | Adult | Programs of Excellence | PerformanceELITE | Hospital: $248,000 | Professonal: $39,000 | 20 | Hospital: $4,500 | Professional: $950 | 90% of Billed Charges | Hospital Inpatient: $4,500 Per Diem | Hospital Outpatient: 70% of Billed Charges | Professional Inpatient: $950 Per Diem | Professional Outpatient: 70% of Billed Charges | Acute Rehab: 70% of Billed Charges | Included in Case Rate | Reimbursed at 120% of Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 33.6056711 | -112.4052341 | |||||||||||||||
Cedars-Sinai Medical Center | Transplant | Los Angeles | CA | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceQUALITY | $120,000 | 25 | N/A | $3,200 Med/Surg | $4,000 ICU/CCU | 80% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | ||||||||||||||
Cedars-Sinai Medical Center | Transplant | Los Angeles | CA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | $140,000 | 30 | N/A | $3,200 Med/Surg | $4,000 ICU/CCU | 80% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | ||||||||||||||
Cedars-Sinai Medical Center | Transplant | Los Angeles | CA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceQUALITY | $160,000 | 35 | N/A | $3,200 Med/Surg | $4,000 ICU/CCU | 80% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | ||||||||||||||
Cedars-Sinai Medical Center | Transplant | Los Angeles | CA | Heart | Heart | Adult | Programs of Excellence | PerformanceSELECT | $143,000 | 16 | $2,400. Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Charges Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and Ends upon Discharge | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | |||||||||||||||
Cedars-Sinai Medical Center | Transplant | Los Angeles | CA | Heart/Lung | Heart/Lung | Adult | Member's Choice | $192,000 | 29 | $2,400 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Charges Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and Ends upon Discharge | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | ||||||||||||||||
Cedars-Sinai Medical Center | Transplant | Los Angeles | CA | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | $103,000 | 8 | $2,400 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Charges Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and Ends upon Discharge | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | |||||||||||||||
Cedars-Sinai Medical Center | Transplant | Los Angeles | CA | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $130,000 | 13 | $2,400 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Charges Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and Ends upon Discharge | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | ||||||||||||||||
Cedars-Sinai Medical Center | Transplant | Los Angeles | CA | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | $182,000 | 24 | $2,400 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Charges Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and Ends upon Discharge | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | |||||||||||||||
Cedars-Sinai Medical Center | Transplant | Los Angeles | CA | Lung | Lung | Adult | Member's Choice | $160,000 | 24 | $2,400 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Charges Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and Ends upon Discharge | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | ||||||||||||||||
Cedars-Sinai Medical Center | Transplant | Los Angeles | CA | Pancreas | Pancreas | Adult | Member's Choice | $107,000 | 10 | $2,400 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Charges Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and Ends upon Discharge | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | ||||||||||||||||
Children's Hospital Los Angeles | Transplant | Los Angeles | CA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | Hospital: $178,000 | Professional Match: $19,630 | Professional Partial Match: $28,200 | Professional Haploidentical T-Cell Depleted: $31,100 | 45 | N/A | Hospital: $2,750 Med/Surg | Hospital: $5,500 ICU/CCU | Professional: 60% of Billed Charges | 90% of Billed Charges | Hospital Inpatient: Reimbursed at the Lesser of 90% of Billed Charges or a Per Diem of $2,750 Med/Surg or $5,500 ICU/CCU | Hospital Outpatient Services and Supplies: Shall be Reimbursed at 75% of Billed Charges | Professional Inpatient Services and Supplies: Shall be Reimbursed at 60% of Billed Charges | Professional Outpatient Services and Supplies: Shall be Reimbursed at 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | Hospital: 50% of Billed Charges | Professional: -N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | |||||||||||||||
Children's Hospital Los Angeles | Transplant | Los Angeles | CA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | Hospital: $230,000 | Professional: $32,100 | 50 | N/A | Hospital: $2,750 Med/Surg | Hospital: $5,500 ICU/CCU | Professional: 60% of Billed Charges | 90% of Billed Charges | Hospital Inpatient: Reimbursed at the Lesser of 90% of Billed Charges or a Per Diem of $2,750 Med/Surg or $5,500 ICU/CCU | Hospital Outpatient Services and Supplies: Shall be Reimbursed at 75% of Billed Charges | Professional Inpatient Services and Supplies: Shall be Reimbursed at 60% of Billed Charges | Professional Outpatient Services and Supplies: Shall be Reimbursed at 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | Hospital: 50% of Billed Charges | Professional: N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | |||||||||||||||
Children's Hospital Los Angeles | Transplant | Los Angeles | CA | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | Hospital: $125,000 | Professional w/o Chemo: $11,687 | Professional w/ Chemo: $22,800 | 30 | N/A | Hospital: $2,750 Med/Surg | Hospital: $5,500 ICU/CCU |Professional: 60% of Billed Charges | 90% of Billed Charges | Hospital Inpatient: Reimbursed at the Lesser of 90% of Billed Charges or a Per Diem of $2,750 Med/Surg or $5,500 ICU/CCU | Hospital Outpatient Services and Supplies: Shall be Reimbursed at 75% of Billed Charges | Professional Inpatient Services and Supplies: Shall be Reimbursed at 60% of Billed Charges | Professional Outpatient Services and Supplies: Shall be Reimbursed at 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | Hospital: 50% of Billed Charges | Professional: N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | |||||||||||||||
Children's Hospital Los Angeles | Transplant | Los Angeles | CA | Heart | Heart | Pediatric | Programs of Excellence | Hospital: $171,000 | Professional: $17,420 | Hospital: 26 | Professional: 21 | Hospital: $2,750 Med/Surg | Hospital: $5,500 ICU/CCU | Professional: 60% of Billed Charges | 90% of Billed Charges | Hospital Inpatient: Reimbursed at the Lesser of 90% of Billed Charges or a Per Diem of $2,750 Med/Surg or $5,500 ICU/CCU | Hospital Outpatient Services and Supplies: Shall be Reimbursed at 75% of Billed Charges | Professional Inpatient Services and Supplies: Shall be Reimbursed at 60% of Billed Charges | Professional Outpatient Services and Supplies: Shall be Reimbursed at 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | Hospital: 50% of Billed Charges Professional: N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | ||||||||||||||||
Children's Hospital Los Angeles | Transplant | Los Angeles | CA | Kidney | Kidney | Pediatric | Programs of Excellence | Hospital Cadaveric Donor: $69,550 | Hospital Living Donor: $72,100.00 | Professional Cadaveric Donor: $75,000 | Professional Living Donor: $7,000 | Hospital Cadaveric Donor: 10 | Hospital Living Donor: 10 | Professional Cadaveric Donor: 14 | Professional Living Donor: 10 | Hospital: $2,750 Med/Surg Hospital: $5,500 ICU/CCU Professional: 60% of Billed Charges | 90% of Billed Charges | Hospital Inpatient: Reimbursed at the Lesser of 90% of Billed Charges or a Per Diem of $2,750 Med/Surg or $5,500 ICU/CCU | Hospital Outpatient Services and Supplies: Shall be Reimbursed at 75% of Billed Charges | Professional Inpatient Services and Supplies: Shall be Reimbursed at 60% of Billed Charges | Professional Outpatient Services and Supplies: Shall be Reimbursed at 70% of Billed Charges | Included in Case Rate | N/A | Hospital: 50% of Billed Charges Professional: N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | ||||||||||||||||
Children's Hospital Los Angeles | Transplant | Los Angeles | CA | Liver | Liver | Pediatric | Programs of Excellence | Hospital Cadaveric Donor: $141,000| Hospital Living Donor: $107,205 | Professional Cadaveric Donor: $26,600 | Professional Living Donor: $31,600 | Hospital Cadaveric Donor: 20 | Hospital Living Donor: 20 | Professional Cadaveric Donor: 21 | Professional Living Donor: 21 | Hospital: $2,750 Med/Surg | Hospital: $5,500 ICU/CCU | Professional: 60% of Billed Charges | 90% of Billed Charges | Hospital Inpatient: Reimbursed at the Lesser of 90% of Billed Charges or a Per Diem of $2,750 Med/Surg or $5,500 ICU/CCU | Hospital Outpatient Services and Supplies: Shall be Reimbursed at 75% of Billed Charges | Professional Inpatient Services and Supplies: Shall be Reimbursed at 60% of Billed Charges | Professional Outpatient Services and Supplies: Shall be Reimbursed at 70% of Billed Charges | N/A | N/A | Included in Case Rate | N/A | Hospital: 50% of Billed Charges | Professional: N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | ||||||||||||||
City of Hope National Medical Center | Transplant | Duarte | CA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceELITE | Hospital: $157,500 | Professional: $19,000 | Hospital: N/A | Professional: 30 | N/A | Hospital: N/A |Professional: $400 Med/Surg | Professional: $400 ICU/CCU | 90% of Billed Charges | Hospital: 75% of Billed Charges | Professional: 70% of Billed Charges | Hospital: 75% of Billed Charges | Professional: Included in Case Rate | Reimbursed at Invoice Cost + 10% | Hospital: 60% of Billed Charges | Professional: 55% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends upon Discharge or the last Day of Infusion for an Outpatient Transplant | Ends One (1) Year from the End of the Transplant Phase | 34.1579217 | -117.9926429 | ||||||||||||||
City of Hope National Medical Center | Transplant | Duarte | CA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceELITE | Hospital: $210,000 | Professional: $23,805 | Hospital: N/A | Professional: 35 | N/A | Hospital: N/A |Professional: $450 Med/Surg | Professional: $450 ICU/CCU | 90% of Billed Charges | Hospital: 75% of Billed Charges | Professional: 70% of Billed Charges | Hospital: 75% of Billed Charges | Professional: Included in Case Rate | Reimbursed at Invoice Cost + 10% | Hospital: 60% of Billed Charges | Professional: 55% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends upon Discharge or the last Day of Infusion for an Outpatient Transplant | Ends One (1) Year from the End of the Transplant Phase | 34.1579217 | -117.9926429 | ||||||||||||||
City of Hope National Medical Center | Transplant | Duarte | CA | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceELITE | Hospital: $115,000 | Professional: $15,500 | Hosptial: N/A | Professional: 20 | N/A | Hospital: N/A | Professional: $375 Med/Surg | Professional: $375 ICU/CCU | 90% of Billed Charges | Hospital: 75% of Billed Charges | Professional: 70% of Billed Charges | Hospital: 75% of Billed Charges | Professional: Included in Case Rate | Reimbursed at Invoice Cost + 10% | Hospital: 60% of Billed Charges | Professional: 55% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends upon Discharge or the last Day of Infusion for an Outpatient Transplant | Ends One (1) Year from the End of the Transplant Phase | 34.1579217 | -117.9926429 | ||||||||||||||
City of Hope National Medical Center | Transplant | Duarte | CA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | Hospital: $157,500 | Professional: $19,000 | Hospital: N/A | Professional: 30 | N/A | Hospital: N/A | Professional: $400 Med/Surg | Professional: $400 ICU/CCU | 90% of Billed Charges | Hospital: 75% of Billed Charges | Professional: 70% of Billed Charges | Hospital: 75% of Billed Charges | Professional: Included in Case Rate | Reimbursed at Invoice Cost + 10% | Hospital: 60% of Billed Charges | Professional: 55% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends upon Discharge or the last Day of Infusion for an Outpatient Transplant | Ends One (1) Year from the End of the Transplant Phase | 34.1579217 | -117.9926429 | |||||||||||||||
City of Hope National Medical Center | Transplant | Duarte | CA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | Hospital: $210,000 | Professional: $23,805 | Hospital: N/A | Professional: 35 | N/A | Hospital: N/A | Professional: $450 Med/Surg Professional $450 ICU/CCU | 90% of Billed Charges | Hospital: 75% of Billed Charges | Professional: 70% of Billed Charges | Hospital: 75% of Billed Charges | Professional: Included in Case Rate | Reimbursed at Invoice Cost + 10% | Hospital: 60% of Billed Charges | Professional: 55% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends upon Discharge or the last Day of Infusion for an Outpatient Transplant | Ends One (1) Year from the End of the Transplant Phase | 34.1579217 | -117.9926429 | |||||||||||||||
City of Hope National Medical Center | Transplant | Duarte | CA | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | Hospital: $115,000 | Professional $15,500 | N/A 20 | N/A | Hospital: N/A | Professional: $375 Med/Surg | Professional: $375 ICU/CCU | 90% of Billed Charges | Hospital 75% of Billed Charges Professional 70% of Billed Charges | Hospital - 75% of Billed Charges Professional Included in Case Rate | Reimbursed at Invoice Cost + 10% | Hospital 60% of Billed Charges Professional 55% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends upon Discharge or the last Day of Infusion for an Outpatient Transplant | Ends One (1) Year from the End of the Transplant Phase | 34.1579217 | -117.9926429 | |||||||||||||||
Keck Hospital of USC | Transplant | Los Angeles | CA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceSELECT | $201,250 | 30 | In its entirety â from First Day of Ablative Therapy Through the Day of last Infusion â Occurs Completely on an Outpatient basis | 45% of Billed Charges | 90% of Billed Charges | 45% of Billed Charges | 45% of Billed Charges | 45% of Billed Charges | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | ||||||||||||||
Keck Hospital of USC | Transplant | Los Angeles | CA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceSELECT | $247,250 | 35 | In its entirety â from First Day of Ablative Therapy Through the Day of last Infusion â Occurs Completely on an Outpatient basis | 45% of Billed Charges | 90% of Billed Charges | 45% of Billed Charges | 45% of Billed Charges | 45% of Billed Charges | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | ||||||||||||||
Keck Hospital of USC | Transplant | Los Angeles | CA | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceSELECT | $120,750 | 25 | In its entirety â from First Day of Ablative Therapy Through the Day of last Infusion â Occurs Completely on an Outpatient basis | 45% of Billed Charges | 90% of Billed Charges | 45% of Billed Charges | 45% of Billed Charges | 45% of Billed Charges | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | ||||||||||||||
Keck Hospital of USC | Transplant | Los Angeles | CA | Heart | Heart | Adult | Programs of Excellence | PerformanceELITE | $106,950 | 18 | 45% of Billed Charges | 90% of Billed Charges | 45% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | |||||||||||||||
Keck Hospital of USC | Transplant | Los Angeles | CA | Heart/Lung | Heart/Lung | Adult | Member's Choice | $1897,50 | 28 | 45% of Billed Charges | 90% of Billed Charges | 45% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | ||||||||||||||||
Keck Hospital of USC | Transplant | Los Angeles | CA | Kidney | Kidney | Adult | Member's Choice | Cadeveric Donor: $86,250 | Living Donor: $74,750 | Donor Services: $32,200 | 12 | 45% of Billed Charges | 90% of Billed Charges | 45% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | ||||||||||||||||
Keck Hospital of USC | Transplant | Los Angeles | CA | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceQUALITY | $111,550 | 18 | 45% of Billed Charges | 90% of Billed Charges | 45% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | |||||||||||||||
Keck Hospital of USC | Transplant | Los Angeles | CA | Liver | Liver | Adult | Programs of Excellence | PerformanceSELECT | Cadeveric Donor: $169,050 | Living Donor: $161,000 | Donor Services: $32,200 | 24 | 45% of Billed Charges | 90% of Billed Charges | 45% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | |||||||||||||||
Keck Hospital of USC | Transplant | Los Angeles | CA | Lung | Lung | Adult | Member's Choice | Cadeveric Donor Single: $148,350 | Cadeveric Donor Bilateral: $184,000 | Living Donor Single: $166,750 | Living Donor Bilateral: $157,550 | Donor Services: $31,000 | 21 | Donor Services: 12 | N/A | 90% of Billed Charges | 45% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | ||||||||||||||||
Lucile Salter Packard Children's Hospital at Stanford | Transplant | Palo Alto | CA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $217,000 | N/A | N/A | N/A | 70% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | Any Charges that Exceed $450,000 Shall be Reimbursed at 50% of Billed Charges, in Addition to the Case Rate | Begins at Evaluation | Begins on the Day of Admission for Ablative Therapy and Ends at Discharge | Ends 365 Days from Discharge | 37.425713 | -122.1703694 | |||||||||||||||
Lucile Salter Packard Children's Hospital at Stanford | Transplant | Palo Alto | CA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $238,000 | N/A | N/A | N/A | 70% of Billed Charges | 60% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | Any Charges that Exceed $500,000 Shall be Reimbursed at 50% of Billed Charges, in Addition to the Case Rate | Begins at Evaluation | Begins on the Day of Admission for Ablative Therapy and Ends at Discharge | Ends 365 Days from Discharge | 37.425713 | -122.1703694 | |||||||||||||||
Lucile Salter Packard Children's Hospital at Stanford | Transplant | Palo Alto | CA | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $152,000 | N/A | N/A | N/A | 70% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | Any Charges that Exceed $320,000 Shall be Reimbursed at 50% of Billed Charges, in Addition to the Case Rate | Begins at Evaluation | Begins on the Day of Admission for Ablative Therapy and Ends at Discharge | Ends 365 Days from Discharge | 37.425713 | -122.1703694 | |||||||||||||||
Lucile Salter Packard Children's Hospital at Stanford | Transplant | Palo Alto | CA | Heart | Heart | Pediatric | Programs of Excellence | $280,000 | N/A | N/A | 70% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | Any Charges that Exceed $575,000 Shall be Reimbursed at 50% of Billed Charges, in Addition to the Case Rate | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 37.425713 | -122.1703694 | ||||||||||||||||
Lucile Salter Packard Children's Hospital at Stanford | Transplant | Palo Alto | CA | Heart/Lung | Heart/Lung | Pediatric | Member's Choice | $450,000 | N/A | N/A | 70% of Billed Charges | 60% of Billed Charges | First Organ: Included in Case Rate | Second and any Additional Organs: Paid at invoice Cost | Reimbursed at Invoice Cost | Any Charges that Exceed $937,500 Shall be Reimbursed at 50% of Billed Charges, in Addition to the Case Rate | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 37.425713 | -122.1703694 | ||||||||||||||||
Lucile Salter Packard Children's Hospital at Stanford | Transplant | Palo Alto | CA | Kidney | Kidney | Pediatric | Programs of Excellence | Cadeveric Donor: $145,000 | Living Donor: $130,000 | N/A | N/A | 70% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | Any Charges that Exceed $300,000 (Cadaveric) or $270,000 (Living) Shall be Reimbursed at 50% of Billed Charges, in Addition to the Case Rate | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 37.425713 | -122.1703694 | ||||||||||||||||
Lucile Salter Packard Children's Hospital at Stanford | Transplant | Palo Alto | CA | Liver | Liver | Pediatric | Programs of Excellence | Cadeveric Donor: $238,000 | Living Donor: $264,000 | N/A | N/A | 70% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | Any Charges that Exceed $500,000 (Cadaveric) or $535,000 (Living) Shall be Reimbursed at 50% of Billed Charges, in Addition to the Case Rate | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 37.425713 | -122.1703694 | ||||||||||||||||
Lucile Salter Packard Children's Hospital at Stanford | Transplant | Palo Alto | CA | Lung | Lung | Pediatric | Programs of Excellence | Single or Bilateral: 310,000 | N/A | N/A | 70% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | Any Charges that Exceed $650,000 Shall be Reimbursed at 50% of Billed Charges, in Addition to the Case Rate | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 37.425713 | -122.1703694 | ||||||||||||||||
Rady Children's Hospital and Health Center | Transplant | Encinitas | CA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $160,000 | 35 | Provisions the same as Inpatient | 65% of Billed Charges | 85% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 33.0441071 | -117.2892539 | |||||||||||||||
Rady Children's Hospital and Health Center | Transplant | Encinitas | CA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $225,000 | 40 | Provisions the same as Inpatient | 65% of Billed Charges | 85% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 33.0441071 | -117.2892539 | |||||||||||||||
Rady Children's Hospital and Health Center | Transplant | Encinitas | CA | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $120,000 | 30 | Provisions the same as Inpatient | 65% of Billed Charges | 85% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 33.0441071 | -117.2892539 | |||||||||||||||
Rady Children's Hospital and Health Center | Transplant | Encinitas | CA | Kidney | Kidney | Pediatric | Programs of Excellence | $90,000 | 15 | 65% of Billed Charges | 85% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 33.0441071 | -117.2892539 | ||||||||||||||||
Rady Children's Hospital and Health Center | Transplant | Encinitas | CA | Liver | Liver | Pediatric | Member's Choice | $200,000 | 25 | 65% of Billed Charges | 85% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 33.0441071 | -117.2892539 | ||||||||||||||||
Scripps Green Hospital | Transplant | San Diego | CA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | $125,000 | N/A | Begin on the First Day of Ablative Therapy Through the Date of last Infusion | N/A | 65% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | Any Charges that Exceed $312,500 in Billed Charges Shall be Reimbursed at 70% of Billed Charges in Addition to the Case Rate | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 365 Days from Discharge | 32.8248175 | -117.3891618 | |||||||||||||||
Scripps Green Hospital | Transplant | San Diego | CA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | $140,000 | N/A | Begin on the First Day of Ablative Therapy Through the Date of last Infusion | N/A | 65% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | Any Charges that Exceed $350,000 in Billed Charges Shall be Reimbursed at 70% of Billed Charges in Addition to the Case Rate | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 365 Days from Discharge | 32.8248175 | -117.3891618 | |||||||||||||||
Scripps Green Hospital | Transplant | San Diego | CA | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $80,000 | N/A | Begin on the First Day of Ablative Therapy Through the Date of last Infusion | N/A | 65% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | Any Charges that Exceed $200,000 in Billed Charges Shall be Reimbursed at 70% of Billed Charges in Addition to the Case Rate | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 365 Days from Discharge | 32.8248175 | -117.3891618 | |||||||||||||||
Scripps Green Hospital | Transplant | San Diego | CA | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | Cadaveric Donor: $55,000: | Living Donor: $75,000 | N/A | N/A | 65% of Billed Charges | 70% of Billed Charges | Cadaveric Donor: Reimbursed at Invoice Cost | Living Donor: Included in Case Rate | N/A | Any Charges that Exceed $162,500 (Cadaveric) or $195,000 (Living), Shall be Reimbursed at 70% of Billed Charges in Addition to the Case Rate | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 32.8248175 | -117.3891618 | |||||||||||||||
Scripps Green Hospital | Transplant | San Diego | CA | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $80,000 | N/A | N/A | 65% of Billed Charges | 70% of Billed Charges | Donor Charges Reimbursed at Invoice Cost | N/A | Any Charges that Exceed $212,500 will be Reimbursed at 70% of Billed Charges in Addition to the Case Rate | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 32.8248175 | -117.3891618 | ||||||||||||||||
Scripps Green Hospital | Transplant | San Diego | CA | Liver | Liver | Adult | Member's Choice | Cadaveric Donor: $120,000 | Living Donor: $160,000 | N/A | N/A | 65% of Billed Charges | 70% of Billed Charges | Cadaveric Donor: Reimbursed at Invoice Cost | Living Donor: Included in Case Rate | N/A | Any Charges that Exceed $312,500 (Cadaveric) or $400,000 (Living), will be Reimbursed at 70% of Billed Charges in Addition to the Case Rate | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 32.8248175 | -117.3891618 | ||||||||||||||||
Scripps Green Hospital | Transplant | San Diego | CA | Pancreas | Pancreas | Adult | Member's Choice | $70,000 | N/A | N/A | 65% of Billed Charges | 70% of Billed Charges | Donor Charges Reimbursed at Invoice Cost | N/A | Any Charges that Exceed $187,500 will be Reimbursed at 70% of Billed Charges in Addition to the Case Rate | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 32.8248175 | -117.3891618 | ||||||||||||||||
Stanford Health Care | Transplant | Palo Alto | CA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceSELECT | $407,000 | 100 | The Inlier Days period Shall begin on the Date of the Ablative Therapy and conclude at the End of the Inlier Days | $20,000 | 70% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when the Inlier Days and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 37.425713 | -122.1703694 | ||||||||||||||
Stanford Health Care | Transplant | Palo Alto | CA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceSELECT | $522,500 | 100 | The Inlier Days period Shall begin on the Date of the Ablative Therapy and conclude at the End of the Inlier Days | $20,000 | 70% of Billed Charges | 60% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when the Inlier Days and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 37.425713 | -122.1703694 | ||||||||||||||
Stanford Health Care | Transplant | Palo Alto | CA | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceSELECT | $340,000 | 60 | The Inlier Days period Shall begin on the Date of the Ablative Therapy and conclude at the End of the Inlier Days | $20,000 | 70% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when the Inlier Days and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 37.425713 | -122.1703694 | ||||||||||||||
Stanford Health Care | Transplant | Palo Alto | CA | Heart | Heart | Adult | Programs of Excellence | PerformanceSELECT | $1,089,000 | 25 | $25,000 | 70% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 37.425713 | -122.1703694 | |||||||||||||||
Stanford Health Care | Transplant | Palo Alto | CA | Kidney | Kidney | Adult | Member's Choice | Cadaveric Donor: $308,000 | Living Donor $297,000 | 10 | $25,000 | 70% of Billed Charges | 60% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 37.425713 | -122.1703694 | ||||||||||||||||
Stanford Health Care | Transplant | Palo Alto | CA | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $388,000 | 20 | $25,000 | 70% of Billed Charges | 60% of Billed Charges | First Organ: Included in Case Rate | Second and any Additional Organs: Shall be Paid at 100% of Invoice Cost | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 37.425713 | -122.1703694 | ||||||||||||||||
Stanford Health Care | Transplant | Palo Alto | CA | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | Cadaveric or Living Donor: $440,000 | 20 | $25,000 | 70% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 37.425713 | -122.1703694 | |||||||||||||||
Stanford Health Care | Transplant | Palo Alto | CA | Lung | Lung | Adult | Programs of Excellence | PerformanceQUALITY | Single or Bilateral: $1,094,500 | 30 | $25,000 | 70% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 37.425713 | -122.1703694 | |||||||||||||||
Stanford Health Care | Transplant | Palo Alto | CA | Pancreas | Pancreas | Adult | Member's Choice | $209,000 | 20 | $25,000 | 70% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 37.425713 | -122.1703694 | ||||||||||||||||
University of California at Los Angeles Medical Center | Transplant | Los Angeles | CA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | Hospital: $156,600 | Professional: $22,140 | N/A | N/A | N/A | 90% of Billed Charges | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | Included in Case Rate | Reimbursed at the pre/post payable Rate | Hospital 525% of Billed Charges Professional 70% of Billed Charges Anesthesia Services 80% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | |||||||||||||||
University of California at Los Angeles Medical Center | Transplant | Los Angeles | CA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | Hospital: $189,000 | Professional: $25,920 | N/A | N/A | N/A | 90% of Billed Charges | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | Included in Case Rate | Reimbursed at the pre/post payable Rate | Hospital 525% of Billed Charges Professional 70% of Billed Charges Anesthesia Services 80% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | |||||||||||||||
University of California at Los Angeles Medical Center | Transplant | Los Angeles | CA | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | Hospital: $102,600 | Professional: $21,060 | N/A | N/A | N/A | 90% of Billed Charges | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | Included in Case Rate | Reimbursed at the pre/post payable Rate | Hospital 525% of Billed Charges Professional 70% of Billed Charges Anesthesia Services 80% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | |||||||||||||||
University of California at Los Angeles Medical Center | Transplant | Los Angeles | CA | Heart | Heart | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $189,000 | Professional: $44,280 | N/A | N/A | 90% of Billed Charges | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | Included in Case Rate | Reimbursed at 33% of Billed Charges | Hospital 525% of Billed Charges Professional 70% of Billed Charges Anesthesia Services 80% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from the Date of Transplant | 34.0207305 | -118.6919155 | |||||||||||||||
University of California at Los Angeles Medical Center | Transplant | Los Angeles | CA | Heart/Lung | Heart/Lung | Adult | Member's Choice | Hospital: 70% of Billed Charges | Professional: 75% of Billed Charges | N/A | N/A | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | 100% of the Medicare Allowable | Reimbursed at 33% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from the Date of Transplant | 34.0207305 | -118.6919155 | |||||||||||||||||
University of California at Los Angeles Medical Center | Transplant | Los Angeles | CA | Islet | Islet | Adult | Member's Choice | Excluding Processing & Transport Hospital: 70% of Billed Charges | Professional: 80% of Billed Charges | Processing and Transport Hospital: 100% of Billed Charges | Professional: 80% of Billed Charges | N/A | N/A | 90% of Billed Charges | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | Included in Case Rate | Reimbursed at 33% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from the Date of Transplant | 34.0207305 | -118.6919155 | ||||||||||||||||
University of California at Los Angeles Medical Center | Transplant | Los Angeles | CA | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | Cadaveric Donor Hospital: $108,000 | Cadaveric Donor Professional: $18,900 | Living Donor Hospital: $108,000 | Living Donor Professional: $21,060 | N/A | N/A | 90% of Billed Charges | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | Included in Case Rate | Reimbursed at 33% of Billed Charges | Hospital 525% of Billed Charges Professional 70% of Billed Charges Anesthesia Services 80% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from the Date of Transplant | 34.0207305 | -118.6919155 | |||||||||||||||
University of California at Los Angeles Medical Center | Transplant | Los Angeles | CA | Kidney/Liver | Kidney/Liver | Adult | Member's Choice | Hospital: $259,200 | Professional: $59,940 | N/A | N/A | 90% of Billed Charges | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | Included in Case Rate | Reimbursed at 33% of Billed Charges | Hospital 525% of Billed Charges Professional 70% of Billed Charges Anesthesia Services 80% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from the Date of Transplant | 34.0207305 | -118.6919155 | ||||||||||||||||
University of California at Los Angeles Medical Center | Transplant | Los Angeles | CA | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | Hospital: $297,000 | Professional: $61,781 | N/A | N/A | 90% of Billed Charges | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | Included in Case Rate | Reimbursed at 33% of Billed Charges | Hospital 525% of Billed Charges Professional 70% of Billed Charges Anesthesia Services 80% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from the Date of Transplant | 34.0207305 | -118.6919155 | ||||||||||||||||
University of California at Los Angeles Medical Center | Transplant | Los Angeles | CA | Liver | Liver | Adult | Member's Choice | Cadaveric Donor Hospital: $189,000 | Cadaveric Donor Professional: $49,140 | Living Donor Hospital: $189,000 | Living Donor Professional: $61,560 | N/A | N/A | 90% of Billed Charges | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | Included in Case Rate | Reimbursed at 33% of Billed Charges | Hospital 525% of Billed Charges Professional 70% of Billed Charges Anesthesia Services 80% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from the Date of Transplant | 34.0207305 | -118.6919155 | ||||||||||||||||
University of California at Los Angeles Medical Center | Transplant | Los Angeles | CA | Lung | Lung | Adult | Programs of Excellence | PerformanceSELECT | Hospital (Single): $189,000 | Professional (Single): $48,600 | Hospital (Bilateral): $297,000 | Professional (Bilateral): $58,914 | N/A | N/A | 90% of Billed Charges | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | Included in Case Rate | Reimbursed at 33% of Billed Charges | Hospital 525% of Billed Charges Professional 70% of Billed Charges Anesthesia Services 80% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from the Date of Transplant | 34.0207305 | -118.6919155 | |||||||||||||||
University of California at Los Angeles Medical Center | Transplant | Los Angeles | CA | Multi-Visceral | Multi-Visceral | Adult | Member's Choice | Hospital: $270,000 | Professional: $88,020 | N/A | N/A | 90% of Billed Charges | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | Included in Case Rate | Reimbursed at 33% of Billed Charges | Hospital 525% of Billed Charges Professional 70% of Billed Charges Anesthesia Services 80% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from the Date of Transplant | 34.0207305 | -118.6919155 | ||||||||||||||||
University of California at Los Angeles Medical Center | Transplant | Los Angeles | CA | Pancreas | Pancreas | Adult | Member's Choice | Hospital: $135,000 | Professional: $30,240 | N/A | N/A | 90% of Billed Charges | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | Included in Case Rate | Reimbursed at 33% of Billed Charges | Hospital 525% of Billed Charges Professional 70% of Billed Charges Anesthesia Services 80% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from the Date of Transplant | 34.0207305 | -118.6919155 | ||||||||||||||||
University of California at Los Angeles Medical Center | Transplant | Los Angeles | CA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | Hospital: $102,600 | Professional: $21,060 | N/A | N/A | N/A | 90% of Billed Charges | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | Included in Case Rate | Reimbursed at the pre/post payable Rate | Hospital 525% of Billed Charges Professional 70% of Billed Charges Anesthesia Services 80% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | |||||||||||||||
University of California at Los Angeles Medical Center | Transplant | Los Angeles | CA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | Hospital: $156,600 | Professional: $22,140 | N/A | N/A | N/A | 90% of Billed Charges | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | Included in Case Rate | Reimbursed at the pre/post payable Rate | Hospital 525% of Billed Charges Professional 70% of Billed Charges Anesthesia Services 80% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | |||||||||||||||
University of California at Los Angeles Medical Center | Transplant | Los Angeles | CA | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | Hospital: $189,000 | Professional: $25,920 | N/A | N/A | N/A | 90% of Billed Charges | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | Included in Case Rate | Reimbursed at the pre/post payable Rate | Hospital 525% of Billed Charges Professional 70% of Billed Charges Anesthesia Services 80% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 365 Days from Discharge | 34.0207305 | -118.6919155 | |||||||||||||||
University of California at Los Angeles Medical Center | Transplant | Los Angeles | CA | Heart | Heart | Pediatric | Programs of Excellence | Hospital: $189,000 | Professional: $44,280 | N/A | N/A | 90% of Billed Charges | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | Included in Case Rate | Reimbursed at 33% of Billed Charges | Hospital 525% of Billed Charges Professional 70% of Billed Charges Anesthesia Services 80% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from the Date of Transplant | 34.0207305 | -118.6919155 | ||||||||||||||||
University of California at Los Angeles Medical Center | Transplant | Los Angeles | CA | Intestine | Intestine | Pediatric | Programs of Excellence | Hospital: $270,000 | Professional: $88,020 | N/A | N/A | 90% of Billed Charges | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | Included in Case Rate | Reimbursed at 33% of Billed Charges | Hospital 525% of Billed Charges Professional 70% of Billed Charges Anesthesia Services 80% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from the Date of Transplant | 34.0207305 | -118.6919155 | ||||||||||||||||
University of California at Los Angeles Medical Center | Transplant | Los Angeles | CA | Kidney | Kidney | Pediatric | Programs of Excellence | Cadaveric Donor Hospital: $108,000 | Cadaveric Donor Professional: $18,900 | Living Donor Hospital: $108,000 | Living Donor Professional: $21,060 | N/A | N/A | 90% of Billed Charges | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | Included in Case Rate | Reimbursed at 33% of Billed Charges | Hospital 525% of Billed Charges Professional 70% of Billed Charges Anesthesia Services 80% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from the Date of Transplant | 34.0207305 | -118.6919155 | ||||||||||||||||
University of California at Los Angeles Medical Center | Transplant | Los Angeles | CA | Liver | Liver | Pediatric | Member's Choice | Cadaveric Donor Hospital: $189,000 | Cadaveric Donor Professional: $49,140 | Living Donor Hospital: $189,000 | Living Donor Professional: $61,560 | N/A | N/A | 90% of Billed Charges | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | Included in Case Rate | Reimbursed at 33% of Billed Charges | Hospital 525% of Billed Charges Professional 70% of Billed Charges Anesthesia Services 80% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from the Date of Transplant | 34.0207305 | -118.6919155 | ||||||||||||||||
University of California San Diego Medical Center | Transplant | San Diego | CA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $139,100 | Professional: $21,400 | 35 | Begins on the First Day of Ablative Therapy and Ends on the Date of the last Infusion | N/A | 80% of Billed Charges | 65% of Billed Charges | Included in the Case Rate | Included in the Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when the Inlier Days have Expired | Ends 365 Days from the End of the Inlier Days | 32.8248175 | -117.3891618 | ||||||||||||||
University of California San Diego Medical Center | Transplant | San Diego | CA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $214,000 | Professional: $32,100 | 40 | Begins on the First Day of Ablative Therapy and Ends on the Date of the last Infusion | N/A | 80% of Billed Charges | 65% of Billed Charges | Included in the Case Rate | Included in the Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when the Inlier Days have Expired | Ends 365 Days from the End of the Inlier Days | 32.8248175 | -117.3891618 | ||||||||||||||
University of California San Diego Medical Center | Transplant | San Diego | CA | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $90,950 | Professional: $16,050 | 30 | Begins on the First Day of Ablative Therapy and Ends on the Date of the last Infusion | N/A | 80% of Billed Charges | 65% of Billed Charges | Included in the Case Rate | Included in the Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when the Inlier Days have Expired | Ends 365 Days from the End of the Inlier Days | 32.8248175 | -117.3891618 | ||||||||||||||
University of California San Diego Medical Center | Transplant | San Diego | CA | Heart | Heart | Adult | Programs of Excellence | PerformanceELITE | Hospital: $149,800 | Professional: $37,450 | 30 | N/A | 80% of Billed Charges | 65% of Billed Charges | Included in Case Rate | Reimbursed at 45% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when the Inlier Days have Expired | Ends 365 Days from the End of the Inlier Days | 32.8248175 | -117.3891618 | |||||||||||||||
University of California San Diego Medical Center | Transplant | San Diego | CA | Heart/Kidney | Heart/Kidney | Adult | Member's Choice | Hospital: $193,670 | Professional: $45,475 | 30 | N/A | 80% of Billed Charges | 65% of Billed Charges | Included in Case Rate | Reimbursed at 45% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when the Inlier Days have Expired | Ends 365 Days from the End of the Inlier Days | 32.8248175 | -117.3891618 | ||||||||||||||||
University of California San Diego Medical Center | Transplant | San Diego | CA | Heart/Lung | Heart/Lung | Adult | Member's Choice | Hospital: $192,600 | Professional: $53,500 | 30 | N/A | 80% of Billed Charges | 65% of Billed Charges | Included in Case Rate | Reimbursed at 45% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when the Inlier Days have Expired | Ends 365 Days from the End of the Inlier Days | 32.8248175 | -117.3891618 | ||||||||||||||||
University of California San Diego Medical Center | Transplant | San Diego | CA | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $87,740 | Professional: $16,050 | 9 | N/A | 80% of Billed Charges | 65% of Billed Charges | Included in Case Rate | Reimbursed at 45% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when the Inlier Days have Expired | Ends 365 Days from the End of the Inlier Days | 32.8248175 | -117.3891618 | |||||||||||||||
University of California San Diego Medical Center | Transplant | San Diego | CA | Kidney/Liver | Kidney/Liver | Adult | Member's Choice | Hospital: $215,070 | Professional: $50,825 | 30 | N/A | 80% of Billed Charges | 65% of Billed Charges | Included in Case Rate | Reimbursed at 45% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when the Inlier Days have Expired | Ends 365 Days from the End of the Inlier Days | 32.8248175 | -117.3891618 | ||||||||||||||||
University of California San Diego Medical Center | Transplant | San Diego | CA | Kidney/Lung | Kidney/Lung | Adult | Member's Choice | Hospital: $204,370 | Professional: $50,825 | 30 | N/A | 80% of Billed Charges | 65% of Billed Charges | Included in Case Rate | Reimbursed at 45% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when the Inlier Days have Expired | Ends 365 Days from the End of the Inlier Days | 32.8248175 | -117.3891618 | ||||||||||||||||
University of California San Diego Medical Center | Transplant | San Diego | CA | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | Hospital: $107,000 | Professional: $32,100 | 15 | N/A | 80% of Billed Charges | 65% of Billed Charges | Included in Case Rate | Reimbursed at 45% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when the Inlier Days have Expired | Ends 365 Days from the End of the Inlier Days | 32.8248175 | -117.3891618 | ||||||||||||||||
University of California San Diego Medical Center | Transplant | San Diego | CA | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $171,200 | Professional: $42,800 | 30 | N/A | 80% of Billed Charges | 65% of Billed Charges | Included in Case Rate | Reimbursed at 45% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when the Inlier Days have Expired | Ends 365 Days from the End of the Inlier Days | 32.8248175 | -117.3891618 | |||||||||||||||
University of California San Diego Medical Center | Transplant | San Diego | CA | Lung | Lung | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $160,500 | Professional: $42,800 | 30 | N/A | 80% of Billed Charges | 65% of Billed Charges | Included in Case Rate | Reimbursed at 45% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when the Inlier Days have Expired | Ends 365 Days from the End of the Inlier Days | 32.8248175 | -117.3891618 | |||||||||||||||
University of California San Diego Medical Center | Transplant | San Diego | CA | Pancreas | Pancreas | Adult | Member's Choice | Hospital: $90,950 | Professional: $16,050 | 15 | N/A | 80% of Billed Charges | 65% of Billed Charges | Included in Case Rate | Reimbursed at 45% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when the Inlier Days have Expired | Ends 365 Days from the End of the Inlier Days | 32.8248175 | -117.3891618 | ||||||||||||||||
University of California San Francisco Medical Center | Transplant | San Francisco | CA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $123,000 | Professional: $22,000 | N/A | N/A | N/A | 90% of Billed Charges | 70% of Billed Charges | Included in the Case Rate | Reimbursed at Invoice Cost Plus 5% | If Billed Charges Exceed $216,000 (hospital) or $36,000 (professional), Payment will be the Transplant Case Rate Plus 55% of the Excess Charges | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends at Discharge | Ends One Year from Discharge | 37.7577627 | -122.4726194 | ||||||||||||||
University of California San Francisco Medical Center | Transplant | San Francisco | CA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $135,000 | Professional: $25,000 | N/A | N/A | N/A | 90% of Billed Charges | 70% of Billed Charges | Included in the Case Rate | Reimbursed at Invoice Cost Plus 5% | If Billed Charges Exceed $237,000 (hospital) or $41,000 (professional), Payment will be the Transplant Case Rate Plus 55% of the Excess Charges | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends at Discharge | Ends One Year from Discharge | 37.7577627 | -122.4726194 | ||||||||||||||
University of California San Francisco Medical Center | Transplant | San Francisco | CA | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $80,000 | Professional: $15,000 | N/A | N/A | N/A | 90% of Billed Charges | 70% of Billed Charges | Included in the Case Rate | Reimbursed at Invoice Cost Plus 5% | If Billed Charges Exceed $140,000 (hospital) or $25,000 (professional), Payment will be the Transplant Case Rate Plus 55% of the Excess Charges | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends at Discharge | Ends One Year from Discharge | 37.7577627 | -122.4726194 | ||||||||||||||
University of California San Francisco Medical Center | Transplant | San Francisco | CA | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $115,000 | Professional: $30,000 | N/A | N/A | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | If Billed Charges Exceed $202,000 (hospital) or $50,000 (professional), Payment will be the Transplant Case Rate Plus 55% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One Year from Discharge | 37.7577627 | -122.4726194 | |||||||||||||||
University of California San Francisco Medical Center | Transplant | San Francisco | CA | Intestine | Intestine | Adult | Member's Choice | Hospital: $170,000 | Professional: $42,000 | N/A | N/A | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | If Billed Charges Exceed $298,000 (hospital) or $70,000 (professional), Payment will be the Transplant Case Rate Plus 55% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One Year from Discharge | 37.7577627 | -122.4726194 | ||||||||||||||||
University of California San Francisco Medical Center | Transplant | San Francisco | CA | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | Cadaveric Donor Hospital: $68,000 | Cadaveric Donor Professional: $15,000 | Living Donor Hospital: $60,000 | Living Donor Professional: $20,000 | N/A | N/A | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | If Cadaveric Billed Charges Exceed $120,000 (hospital) or $25,000 (professional), Payment will be the Transplant Case Rate Plus 55% of the Excess Charges If Living Billed Charges Exceed $106,000 (hospital) or $33,000 (professional), Payment will be the Transplant Case Rate Plus 55% of Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One Year from Discharge | 37.7577627 | -122.4726194 | |||||||||||||||
University of California San Francisco Medical Center | Transplant | San Francisco | CA | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | Hospital: $112,000 | Professional: $28,000 | N/A | N/A | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | If Billed Charges Exceed $197,000 (hospital) or $46,000 (professional), Payment will be the Transplant Case Rate Plus 55% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One Year from Discharge | 37.7577627 | -122.4726194 | ||||||||||||||||
University of California San Francisco Medical Center | Transplant | San Francisco | CA | Liver | Liver | Adult | Programs of Excellence | PerformanceELITE | Cadaveric Donor Hospital: $114,000 | Cadaveric Donor Professional: $34,000 | Living Donor Hospital: $110,000 | Living Donor Professional: $39,000 | N/A | N/A | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | If Cadaveric Billed Charges Exceed $200,000 (hospital) or $56,000 (professional), Payment will be the Transplant Case Rate Plus 55% of the Excess Charges If Living Billed Charges Exceed $193,000 (hospital) or $65,000 (professional), Payment will be the Transplant Case Rate Plus 55% of Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One Year from Discharge | 37.7577627 | -122.4726194 | |||||||||||||||
University of California San Francisco Medical Center | Transplant | San Francisco | CA | Lung | Lung | Adult | Programs of Excellence | PerformanceELITE | Single Hospital: $130,000 | Single Professional: $34,000 | Bilateral Hospital: $145,000 | Bilateral Professional: $36,000 | N/A | N/A | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | If single Billed Charges Exceed $228,000 (hospital) or $56,000 (professional), Payment will be the Transplant Case Rate Plus 55% of the Excess Charges If bilateral Billed Charges Exceed $254,000 (hospital) or $60,000 (professional), Payment will be the Transplant Case Rate Plus 55% of Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One Year from Discharge | 37.7577627 | -122.4726194 | |||||||||||||||
University of California San Francisco Medical Center | Transplant | San Francisco | CA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | Ends One Year from Discharge | 37.7577627 | -122.4726194 | |||||||||||||||
University of California San Francisco Medical Center | Transplant | San Francisco | CA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | Ends One Year from Discharge | 37.7577627 | -122.4726194 | |||||||||||||||
University of California San Francisco Medical Center | Transplant | San Francisco | CA | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | Ends One Year from Discharge | 37.7577627 | -122.4726194 | |||||||||||||||
University of California San Francisco Medical Center | Transplant | San Francisco | CA | Kidney | Kidney | Pediatric | Member's Choice | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | Ends One Year from Discharge | 37.7577627 | -122.4726194 | ||||||||||||||||
University of California San Francisco Medical Center | Transplant | San Francisco | CA | Liver | Liver | Pediatric | Member's Choice | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | Ends One Year from Discharge | 37.7577627 | -122.4726194 | ||||||||||||||||
Children's Hospital Colorado | Transplant | Aurora | CO | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $184,450 | 35 | Provisions the same as Inpatient | $5,534 | N/A | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends when iInlier and any Applicable Outlier Days have Expired | Ends 90 Days from Discharge | 39.6890151 | -104.8269166 | |||||||||||||||
Children's Hospital Colorado | Transplant | Aurora | CO | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $210,800 | 35 | Provisions the same as Inpatient | $5,534 | N/A | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends when iInlier and any Applicable Outlier Days have Expired | Ends 90 Days from Discharge | 39.6890151 | -104.8269166 | |||||||||||||||
Children's Hospital Colorado | Transplant | Aurora | CO | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $152,830 | 30 | Provisions the same as Inpatient | $5,534 | N/A | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends when iInlier and any Applicable Outlier Days have Expired | Ends 90 Days from Discharge | 39.6890151 | -104.8269166 | |||||||||||||||
Children's Hospital Colorado | Transplant | Aurora | CO | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Pediatric | Programs of Excellence | $263,500 | 30 for each Auto | Provisions the same as Inpatient | $5,534 | N/A | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends when iInlier and any Applicable Outlier Days have Expired | Ends 90 Days from Discharge | 39.6890151 | -104.8269166 | |||||||||||||||
Children's Hospital Colorado | Transplant | Aurora | CO | Heart | Heart | Pediatric | Programs of Excellence | $184,450 | 20 | $5,534 | N/A | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 65% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge If Patient is Inpatient when Inlier Days have Expired Then Outlier Days apply until Discharge | Ends 90 Days from Discharge | 39.6890151 | -104.8269166 | ||||||||||||||||
Children's Hospital Colorado | Transplant | Aurora | CO | Kidney | Kidney | Pediatric | Programs of Excellence | $65,348 | 14 | $5,534 | N/A | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 65% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge If Patient is Inpatient when Inlier Days have Expired Then Outlier Days apply until Discharge | Ends 90 Days from Discharge | 39.6890151 | -104.8269166 | ||||||||||||||||
Children's Hospital Colorado | Transplant | Aurora | CO | Liver | Liver | Pediatric | Programs of Excellence | $183,396 | 25 | $5,534 | N/A | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 65% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge If Patient is Inpatient when Inlier Days have Expired Then Outlier Days apply until Discharge | Ends 90 Days from Discharge | 39.6890151 | -104.8269166 | ||||||||||||||||
Porter Adventist Hospital | Transplant | Denver | CO | Kidney | Kidney | Adult | Member's Choice | Cadaveric Donor: $45,000 | Living Donor: $51,000 | 16 | $1,700 Med/Surg | $2,250 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Invoice Cost | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 39.7645187 | -104.9951945 | ||||||||||||||||
Porter Adventist Hospital | Transplant | Denver | CO | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $68,000 | 25 | $1,700 Med/Surg | $2,250 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Invoice Cost | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 39.7645187 | -104.9951945 | ||||||||||||||||
Porter Adventist Hospital | Transplant | Denver | CO | Liver | Liver | Adult | Member's Choice | $115,000 | 30 | $1,700 Med/Surg | $2,250 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Invoice Cost | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 39.7645187 | -104.9951945 | ||||||||||||||||
University of Colorado Hospital | Transplant | Aurora | CO | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceSELECT | $145,000 | 30 | Provisions the same as Inpatient | $4,500 Med/Surg | $4,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 55% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 39.6890151 | -104.8269166 | ||||||||||||||
University of Colorado Hospital | Transplant | Aurora | CO | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceSELECT | $180,000 | 30 | Provisions the same as Inpatient | $4,50000 Med/Surg | $4,50000 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 55% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 39.6890151 | -104.8269166 | ||||||||||||||
University of Colorado Hospital | Transplant | Aurora | CO | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceSELECT | Auto PSC: $120,000 | Auto BMT: $140,000 | 30 | Provisions the same as Inpatient | $4,500 Med/Surg | $4,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 55% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 39.6890151 | -104.8269166 | ||||||||||||||
University of Colorado Hospital | Transplant | Aurora | CO | Heart | Heart | Adult | Programs of Excellence | PerformanceSELECT | $155,000 | 24 | $4,500 Med/Surg | $4,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | If Inserted During Pre/Post Transplant: Reimbursed at 75% of Billed Charges | If Inserted During the Transplant Phase: Included in the Case Rate | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 39.6890151 | -104.8269166 | |||||||||||||||
University of Colorado Hospital | Transplant | Aurora | CO | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | $68,000 | 14 | $3,500 Med/Surg | $3,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 39.6890151 | -104.8269166 | |||||||||||||||
University of Colorado Hospital | Transplant | Aurora | CO | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceSELECT | $117,500 | 14 | $4,500 Med/Surg | $4,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 39.6890151 | -104.8269166 | |||||||||||||||
University of Colorado Hospital | Transplant | Aurora | CO | Liver | Liver | Adult | Programs of Excellence | PerformanceSELECT | Cadaveric Donor: $168,000 | Living Donor: $176,500 | 18 | $3,500 Med/Surg | $3,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 39.6890151 | -104.8269166 | |||||||||||||||
University of Colorado Hospital | Transplant | Aurora | CO | Lung | Lung | Adult | Member's Choice | Single: $165,000 | Bilateral: $180,000 | 20 | $4,500 Med/Surg | $4,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 39.6890151 | -104.8269166 | ||||||||||||||||
University of Colorado Hospital | Transplant | Aurora | CO | Pancreas | Pancreas | Adult | Member's Choice | $89,000 | 14 | $4,500 Med/Surg | $4,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 39.6890151 | -104.8269166 | ||||||||||||||||
Yale New haven Hospital | Transplant | New haven | CT | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceSELECT | $130,000 | 35 | Provisions the same as Inpatient | $2,500 Med/Surg | $3,000 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 41.2983476 | -72.9641153 | ||||||||||||||
Yale New haven Hospital | Transplant | New haven | CT | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceSELECT | $169,000 | 38 | Provisions the same as Inpatient | $2,500 Med/Surg | $3,000 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 41.2983476 | -72.9641153 | ||||||||||||||
Yale New haven Hospital | Transplant | New haven | CT | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceSELECT | $93,000 | 30 | Provisions the same as Inpatient | $2,500 Med/Surg | $3,000 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 41.2983476 | -72.9641153 | ||||||||||||||
Yale New haven Hospital | Transplant | New haven | CT | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | $150,000 | 18 | $2,500 Med/Surg | $3,000 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 41.2983476 | -72.9641153 | |||||||||||||||
Yale New haven Hospital | Transplant | New haven | CT | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | Cadaveric Donor: $72,000 | Living Donor: $78,000 | 12 | $2,500 Med/Surg | $3,000 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 41.2983476 | -72.9641153 | ||||||||||||||||
Yale New haven Hospital | Transplant | New haven | CT | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $101,000 | 18 | $2,500 Med/Surg | $3,000 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 41.2983476 | -72.9641153 | |||||||||||||||||
Yale New haven Hospital | Transplant | New haven | CT | Pancreas | Pancreas | Adult | Member's Choice | $75,000 | 12 | $2,500 Med/Surg | $3,000 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 41.2983476 | -72.9641153 | |||||||||||||||||
Georgetown University Medical Center | Transplant | Washington, DC | DC | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | $90,000 | 15 | $3,000 Med/Surg | $3,500 ICU/CCU | 95% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at 70% of Billed Charges | If Billed Charges Exceed $150,000, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 38.8937091 | -77.0846157 | |||||||||||||||
Georgetown University Medical Center | Transplant | Washington, DC | DC | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceELITE | $135,000 | 20 | $3,000 Med/Surg | $3,500 ICU/CCU | 95% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at 70% of Billed Charges | If Billed Charges Exceed $230,000, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 38.8937091 | -77.0846157 | |||||||||||||||
Georgetown University Medical Center | Transplant | Washington, DC | DC | Liver | Liver | Adult | Programs of Excellence | PerformanceSELECT | Cadaveric Donor: $200,000 | Living Donor: $210,000 | 20 | 25 | $3,000 Med/Surg | $3,500 ICU/CCU | 95% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at 70% of Billed Charges | If Billed Charges Exceed $340,000 (Cadaveric) or $360,000 (Living), Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 38.8937091 | -77.0846157 | |||||||||||||||
Georgetown University Medical Center | Transplant | Washington, DC | DC | Pancreas | Pancreas | Adult | Member's Choice | $100,000 | 16 | $3,000 Med/Surg | $3,500 ICU/CCU | 95% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at 70% of Billed Charges | If Billed Charges Exceed $170,000, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 38.8937091 | -77.0846157 | ||||||||||||||||
Georgetown University Medical Center | Transplant | Washington, DC | DC | Intestine | Intestine | Pediatric | Programs of Excellence | 70% of Billed Charges | N/A | N/A | N/A | N/A | Included in Transplant Rate | Reimbursed at 70% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 38.8937091 | -77.0846157 | ||||||||||||||||
Georgetown University Medical Center | Transplant | Washington, DC | DC | Liver | Liver | Pediatric | Programs of Excellence | Cadaveric Donor: $220,000 | Living Donor: $230,000 | 20 | 25 | $3,000 Med/Surg | $3,500 ICU/CCU | 95% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at 70% of Billed Charges | If Billed Charges Exceed $375,000 (Cadaveric) or $390,000 (Living), Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 38.8937091 | -77.0846157 | ||||||||||||||||
Georgetown University Medical Center | Transplant | Washington, DC | DC | Multi-Visceral | Multi-Visceral | Pediatric | Programs of Excellence | 70% of Billed Charges | N/A | N/A | N/A | N/A | Included in Transplant Rate | Reimbursed at 70% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 38.8937091 | -77.0846157 | ||||||||||||||||
Alfred I DuPont Hospital for Children | Transplant | Wilmington | DE | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $135,000 | 30 | Provisions the same as Inpatient | $3,100 Med/Surg | $3,100 ICU/CCU | 90% of Billed Charges | 95% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year post-Transplant | 39.7299627 | -75.5645038 | |||||||||||||||
Alfred I DuPont Hospital for Children | Transplant | Wilmington | DE | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $185,000 | 30 | Provisions the same as Inpatient | $3,100 Med/Surg | $3,100 ICU/CCU | 90% of Billed Charges | 95% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year post-Transplant | 39.7299627 | -75.5645038 | |||||||||||||||
Alfred I DuPont Hospital for Children | Transplant | Wilmington | DE | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $122,000 | 30 | Provisions the same as Inpatient | $3,100 Med/Surg | $3,100 ICU/CCU | 90% of Billed Charges | 95% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year post-Transplant | 39.7299627 | -75.5645038 | |||||||||||||||
Alfred I DuPont Hospital for Children | Transplant | Wilmington | DE | Liver | Liver | Pediatric | Member's Choice | $176,000 | 19 | $3,100 Med/Surg | $3,100 ICU/CCU | 90% of Billed Charges | 95% of Billed Charges | Included in Case Rate | N/A | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends One (1) Year post-Transplant | 39.7299627 | -75.5645038 | ||||||||||||||||
Broward General Medical Center | Transplant | Fort Lauderdale | FL | Liver | Liver | Adult | Member's Choice | Hospital: $160,000 | Professional: 70% of Billed Charges | 25 | $2,000 Med/Surg | $3,000 ICU/CCU | 80% of Billed Charges | Hospital: 80% of Billed Charges | Professional: 70% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends 365 Days from Discharge | 26.1412497 | -80.215607 | ||||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | $170,222 | 30 | Provisions the same as Inpatient | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Mobilization or Preparative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceQUALITY | $187,352 | 35 | Provisions the same as Inpatient | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Mobilization or Preparative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceQUALITY | $134,759 | 25 | Provisions the same as Inpatient | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Mobilization or Preparative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Adult | Programs of Excellence | PerformanceQUALITY | $219,870 | 40 | Provisions the same as Inpatient | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Mobilization or Preparative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Blood/Marrow (Tandem Auto to Allo) | Tandem Auto to Allo | Adult | Programs of Excellence | PerformanceQUALITY | $252,496 | 45 | Provisions the same as Inpatient | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Mobilization or Preparative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | $272,356 | 25 | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost Plus 10% | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 29.2103982 | -81.1666499 | |||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Heart/Lung | Heart/Lung | Adult | Member's Choice | $340,445 | 25 | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost Plus 10% | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | Cadaveric Donor: $102,133 | Living Donor: $102,133 | 10 8 | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost Plus 10% | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 29.2103982 | -81.1666499 | |||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Kidney/Liver | Kidney/Liver | Adult | Member's Choice | $266,682 | 20 | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost Plus 10% | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $146,107 | 15 | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost Plus 10% | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | Cadaeric Donor: $202,848 | Living Donor: $219,870 | 15 | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost Plus 10% | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 29.2103982 | -81.1666499 | |||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Lung | Lung | Adult | Member's Choice | Single: $266,682 | Bilateral: $340,445 | 20 | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost Plus 10% | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Pancreas | Pancreas | Adult | Member's Choice | $99,296 | 10 | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost Plus 10% | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $170,222 | 30 | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Mobilization or Preparative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $187,352 | 35 | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Mobilization or Preparative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $134,759 | 25 | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Mobilization or Preparative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Pediatric | Programs of Excellence | $219,870 | 40 | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Mobilization or Preparative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Blood/Marrow (Tandem Auto to Allo) | Tandem Auto to Allo | Pediatric | Programs of Excellence | $252,496 | 45 | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Mobilization or Preparative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Heart | Heart | Pediatric | Member's Choice | $272,356 | 25 | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost Plus 10% | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Heart/Lung | Heart/Lung | Pediatric | Member's Choice | $340,445 | 25 | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost Plus 10% | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Kidney | Kidney | Pediatric | Member's Choice | Cadaveric Donor: $102,133 | Living Donor: $102,133 | 10 | 8 | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost Plus 10% | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Kidney/Liver | Kidney/Liver | Pediatric | Member's Choice | $266,682 | 20 | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost Plus 10% | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Kidney/Pancreas | Kidney/Pancreas | Pediatric | Member's Choice | $146,107 | 15 | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost Plus 10% | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Liver | Liver | Pediatric | Member's Choice | Cadaveric Donor: $202,848 | Living Donor: $219,870 | 15 | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost Plus 10% | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Lung | Lung | Pediatric | Member's Choice | Single: $266,682 | Bilateral: $340,445 | 20 | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost Plus 10% | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||||
Florida Hospital Medical Center | Transplant | Daytona Beach | FL | Pancreas | Pancreas | Pediatric | Member's Choice | $99,296 | 10 | $2,979 Med/Surg | $3,262 ICU/CCU | 70% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost Plus 10% | 48% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.2103982 | -81.1666499 | ||||||||||||||||
Jackson Memorial Hospital University of Miami School of Medicine | Transplant | Miami | FL | Heart | Heart | Adult | Member's Choice | Hospital: $259,293 | Professional: $85,323 | 17 | Hospital: Lesser of 80% of Billed Charges or $2,150 Med/Surg; $2,875 ICU/CCU | Professional: 80% of Billed Charges | 80% of Billed Charges | Hospital: 75% of Billed Charges | Professional: 80% of Billed Charges | Included in Case Rate | 65% of Billed Charges | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant for up to 17 (adult) or 35 (pediatric) Consecutive Inpatient Days, and if Applicable, any Outlier Days, Ending the Day of Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | ||||||||||||||||
Jackson Memorial Hospital University of Miami School of Medicine | Transplant | Miami | FL | Heart/Lung | Heart/Lung | Adult | Member's Choice | Hospital: 65% of Billed Charges | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 75% of Billed Charges | Professional: 80% of Billed Charges | Included in Case Rate | 65% of Billed Charges | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ending the Day of Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | ||||||||||||||||
Jackson Memorial Hospital University of Miami School of Medicine | Transplant | Miami | FL | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $161,817 | Professional: $34,439 | Professional (Living Donor): $12,798 | 12 | 3 | Hospital: Lesser of 80% of Billed Charges or $2,150 Med/Surg; $2,875 ICU/CCU | Professional: 80% of Billed Charges | 80% of Billed Charges | Hospital: 75% of Billed Charges | Professional: 80% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ending the Day of Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | |||||||||||||||
Jackson Memorial Hospital University of Miami School of Medicine | Transplant | Miami | FL | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $215,612 | Professional: 80% of Billed Charges | 15 | Hospital: Lesser of 80% of Billed Charges or $2,150 Med/Surg; $2,875 ICU/CCU | Professional: 80% of Billed Charges | 80% of Billed Charges | Hospital: 75% of Billed Charges | Professional: 80% of Billed Charges | Included in Case Rate | 65% of Billed Charges | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ending the Day of Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | |||||||||||||||
Jackson Memorial Hospital University of Miami School of Medicine | Transplant | Miami | FL | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | Hospital Cadaveric Donor: $273,329 | Hospital Living Donor: $288,104 | Professional Cadaveric or Living Donor: $77,101 | Professional Living Donor Services: 80% of Billed Charges | 22 | 25 | 14 | Hospital: Lesser of 80% of Billed Charges or $2,150 Med/Surg; $2,875 ICU/CCU | Professional: 80% of Billed Charges | 80% of Billed Charges | Hospital: 75% of Billed Charges | Professional: 80% of Billed Charges | Included in Case Rate | 65% of Billed Charges | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ending the Day of Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | |||||||||||||||
Jackson Memorial Hospital University of Miami School of Medicine | Transplant | Miami | FL | Lung | Lung | Adult | Member's Choice | Hospital: 65% of Billed Charges | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 75% of Billed Charges | Professional: 80% of Billed Charges | 65% of Billed Charges | 65% of Billed Charges | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ending the Day of Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | ||||||||||||||||
Jackson Memorial Hospital University of Miami School of Medicine | Transplant | Miami | FL | Multi-Visceral | Multi-Visceral | Adult | Programs of Excellence | Hospital: 65% of Billed Charges | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 75% of Billed Charges | Professional: 80% of Billed Charges | 65% of Billed Charges | 65% of Billed Charges | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ending the Day of Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | ||||||||||||||||
Jackson Memorial Hospital University of Miami School of Medicine | Transplant | Miami | FL | Heart | Heart | Pediatric | Member's Choice | Hospital: $273,329 | Professional: 80% of Billed Charges | 35 | Hospital: Lesser of 80% of Billed Charges or $2,150 Med/Surg; $2,875 ICU/CCU | Professional: 80% of Billed Charges | 80% of Billed Charges | Hospital: 75% of Billed Charges | Professional: 80% of Billed Charges | Included in Case Rate | 65% of Billed Charges | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant for up to 17 (adult) or 35 (pediatric) consecutive Inpatient Days, and if Applicable, any Outlier Days, Ending the Day of Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | ||||||||||||||||
Jackson Memorial Hospital University of Miami School of Medicine | Transplant | Miami | FL | Heart/Lung | Heart/Lung | Pediatric | Member's Choice | Hospital: 65% of Billed Charges | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 75% of Billed Charges | Professional: 80% of Billed Charges | Included in Case Rate | 65% of Billed Charges | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ending the Day of Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | ||||||||||||||||
Jackson Memorial Hospital University of Miami School of Medicine | Transplant | Miami | FL | Kidney | Kidney | Pediatric | Programs of Excellence | Hospital: $161,817 | Professional: $38,783 | Professional (Living Donor): $12,798 | 12 | 3 | Hospital: Lesser of 80% of Billed Charges or $2,150 Med/Surg; $2,875 ICU/CCU | Professional: 80% of Billed Charges | 80% of Billed Charges | Hospital: 75% of Billed Charges | Professional: 80% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ending the Day of Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | ||||||||||||||||
Jackson Memorial Hospital University of Miami School of Medicine | Transplant | Miami | FL | Liver | Liver | Pediatric | Programs of Excellence | Hospital Cadaveric Donor: $273,329 | Hospital Living Donor: $288,104 | Professional Cadaveric or Living Donor: $83,772 | Professional Living Donor Services: 80% of Billed Charges | 22 | 25 | 14 | Hospital: Lesser of 80% of Billed Charges or $2,150 Med/Surg; $2,875 ICU/CCU | Professional: 80% of Billed Charges | 80% of Billed Charges | Hospital: 75% of Billed Charges | Professional: 80% of Billed Charges | Included in Case Rate | 65% of Billed Charges | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ending the Day of Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | ||||||||||||||||
Jackson Memorial Hospital University of Miami School of Medicine | Transplant | Miami | FL | Lung | Lung | Pediatric | Member's Choice | Hospital: 65% of Billed Charges | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 75% of Billed Charges | Professional: 80% of Billed Charges | 65% of Billed Charges | 65% of Billed Charges | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ending the Day of Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | ||||||||||||||||
Jackson Memorial Hospital University of Miami School of Medicine | Transplant | Miami | FL | Multi-Visceral | Multi-Visceral | Pediatric | Programs of Excellence | Hospital: 65% of Billed Charges | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 75% of Billed Charges | Professional: 80% of Billed Charges | 65% of Billed Charges | N/A | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ending the Day of Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | ||||||||||||||||
Mayo Clinic Florida | Transplant | Jacksonville | FL | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | Matched Donor: $118,000 | Mismatched Donor: $138,000 | 100 | N/A | 95% of Billed Charges | 75% of Billed Charges | Charges Included in the Transplant Case Rate if Provided During the Inlier Days Period. If Harvesting is Provided Prior to Inlier Period, Reimbursement Shall be at the Pre-Transplant Rate | Included in Case Rate | 70% of Billed Charges | Begins at Evaluation | Begins Ten Days Prior to the Initial Infusion Date and Ends when the Inlier Days have Expired | Ends 365 Days from Discharge | 30.3452116 | -81.8231908 | ||||||||||||||||
Mayo Clinic Florida | Transplant | Jacksonville | FL | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | $138,000 | 100 | N/A | 95% of Billed Charges | 75% of Billed Charges | Charges Included in the Transplant Case Rate if Provided During the Inlier Days Period. If Harvesting is Provided Prior to Inlier Period, Reimbursement Shall be at the Pre-Transplant Rate | Included in Case Rate | 70% of Billed Charges | Begins at Evaluation | Begins Ten Days Prior to the Initial Infusion Date and Ends when the Inlier Days have Expired | Ends 365 Days from Discharge | 30.3452116 | -81.8231908 | ||||||||||||||||
Mayo Clinic Florida | Transplant | Jacksonville | FL | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $69,000 | 50 | N/A | 95% of Billed Charges | 75% of Billed Charges | Charges Included in the Transplant Case Rate if Provided During the Inlier Days Period. If Harvesting is Provided Prior to Inlier Period, Reimbursement Shall be at the Pre-Transplant Rate | Included in Case Rate | 70% of Billed Charges | Begins at Evaluation | Begins Ten Days Prior to the Initial Infusion Date and Ends when the Inlier Days have Expired | Ends 365 Days from Discharge | 30.3452116 | -81.8231908 | ||||||||||||||||
Mayo Clinic Florida | Transplant | Jacksonville | FL | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | $98,000 | N/A | N/A | 95% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant, Unless Patient is Admitted One (1) Day Prior to Transplant, Then the Transplant Phase Begins at Admission and Ends at Discharge | Ends 365 Days from Discharge | 30.3452116 | -81.8231908 | |||||||||||||||
Mayo Clinic Florida | Transplant | Jacksonville | FL | Heart/Lung | Heart/Lung | Adult | Member's Choice | $114,000 | N/A | N/A | 95% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant, Unless Patient is Admitted One (1) Day Prior to Transplant, Then the Transplant Phase Begins at Admission and Ends at Discharge | Ends 365 Days from Discharge | 30.3452116 | -81.8231908 | ||||||||||||||||
Mayo Clinic Florida | Transplant | Jacksonville | FL | Kidney | Kidney | Adult | Programs of Excellence | PerformanceELITE | Cadaveric Donor: $48,000 | Living Donor: $62,000 | N/A | N/A | 95% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant, Unless Patient is Admitted One (1) Day Prior to Transplant, Then the Transplant Phase Begins at Admission and Ends at Discharge | Ends 365 Days from Discharge | 30.3452116 | -81.8231908 | |||||||||||||||
Mayo Clinic Florida | Transplant | Jacksonville | FL | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $98,000 | N/A | N/A | 95% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant, Unless Patient is Admitted One (1) Day Prior to Transplant, Then the Transplant Phase Begins at Admission and Ends at Discharge | Ends 365 Days from Discharge | 30.3452116 | -81.8231908 | ||||||||||||||||
Mayo Clinic Florida | Transplant | Jacksonville | FL | Liver | Liver | Adult | Programs of Excellence | PerformanceSELECT | Cadaveric Donor: $128,000 | Living Donor: $158,000 | N/A | N/A | 95% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant, Unless Patient is Admitted One (1) Day Prior to Transplant, Then the Transplant Phase Begins at Admission and Ends at Discharge | Ends 365 Days from Discharge | 30.3452116 | -81.8231908 | |||||||||||||||
Mayo Clinic Florida | Transplant | Jacksonville | FL | Lung | Lung | Adult | Programs of Excellence | PerformanceSELECT | $104,000 | N/A | N/A | 95% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant, Unless Patient is Admitted One (1) Day Prior to Transplant, Then the Transplant Phase Begins at Admission and Ends at Discharge | Ends 365 Days from Discharge | 30.3452116 | -81.8231908 | |||||||||||||||
Mayo Clinic Florida | Transplant | Jacksonville | FL | Pancreas | Pancreas | Adult | Member's Choice | $69,000 | N/A | N/A | 95% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant, Unless Patient is Admitted One (1) Day Prior to Transplant, Then the Transplant Phase Begins at Admission and Ends at Discharge | Ends 365 Days from Discharge | 30.3452116 | -81.8231908 | ||||||||||||||||
Moffitt Cancer Center | Transplant | Tampa | FL | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceELITE | $125,000 | 90 | N/A | 90% of Billed Charges | 70% of Billed Charges | Charges Included in the Transplant Case Rate if Provided During the Inlier Days | Charges Included in the Transplant Case Rate if Provided During the Inlier Days | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends when Inlier Days have Expired | Ends One (1) Year from Discharge | 27.9947147 | -82.5943645 | |||||||||||||||
Moffitt Cancer Center | Transplant | Tampa | FL | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceELITE | $145,000 | 90 | N/A | 90% of Billed Charges | 70% of Billed Charges | Charges Included in the Transplant Case Rate if Provided During the Inlier Days | Charges Included in the Transplant Case Rate if Provided During the Inlier Days | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends when Inlier Days have Expired | Ends One (1) Year from Discharge | 27.9947147 | -82.5943645 | |||||||||||||||
Moffitt Cancer Center | Transplant | Tampa | FL | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceELITE | $75,000 | 60 | N/A | 90% of Billed Charges | 70% of Billed Charges | Charges Included in the Transplant Case Rate if Provided During the Inlier Days | Charges Included in the Transplant Case Rate if Provided During the Inlier Days | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends when Inlier Days have Expired | Ends One (1) Year from Discharge | 27.9947147 | -82.5943645 | |||||||||||||||
Moffitt Cancer Center | Transplant | Tampa | FL | Blood/Marrow (Cord Blood) | Cord Blood | Adult | Programs of Excellence | PerformanceELITE | $145,000 | 90 | N/A | 90% of Billed Charges | 70% of Billed Charges | Charges Included in the Transplant Case Rate if Provided During the Inlier Days | Charges Included in the Transplant Case Rate if Provided During the Inlier Days | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends when Inlier Days have Expired | Ends One (1) Year from Discharge | 27.9947147 | -82.5943645 | |||||||||||||||
Moffitt Cancer Center | Transplant | Tampa | FL | Blood/Marrow (Tandem Auto to Allo) | Tandem Auto to Allo | Adult | Programs of Excellence | PerformanceELITE | 1st Infusion: $75,000 | 2nd Infusion: $95,000 | 1st Infusion: 120 | 2nd Infusion: 60 | N/A | 90% of Billed Charges | 70% of Billed Charges | Charges Included in the Transplant Case Rate if Provided During the Inlier Days | Charges Included in the Transplant Case Rate if Provided During the Inlier Days | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends when Inlier Days have Expired | Ends One (1) Year from Discharge | 27.9947147 | -82.5943645 | |||||||||||||||
Moffitt Cancer Center | Transplant | Tampa | FL | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Adult | Programs of Excellence | PerformanceELITE | 1st Infusion: $75,000 | 2nd Infusion: $50,000 | 1st Infusion: 120 | 2nd Infusion: 50 | N/A | 90% of Billed Charges | 70% of Billed Charges | Charges Included in the Transplant Case Rate if Provided During the Inlier Days | Charges Included in the Transplant Case Rate if Provided During the Inlier Days | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends when Inlier Days have Expired | Ends One (1) Year from Discharge | 27.9947147 | -82.5943645 | |||||||||||||||
Tampa General Hospital | Transplant | Tampa | FL | Heart | Heart | Adult | Programs of Excellence | PerformanceSELECT | $98,000 | 20 | $2,200 Med/Surg | $3,100 ICU/CCU | 90% of Billed Charges | 65% of Billed Charges | Reimbursed at Invoice Cost | 55% of Billed Charges | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when the Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 27.9947147 | -82.5943645 | |||||||||||||||
Tampa General Hospital | Transplant | Tampa | FL | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | Cadaveric Donor: $48,500 | Living Donor: $42,500 | 15 | $2,200 Med/Surg | $2,850 ICU/CCU | 90% of Billed Charges | 65% of Billed Charges | Cadaveric Donor: Reimbursed at Invoice Cost | Living Donor: Included in Case Rate | 55% of Billed Charges | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when the Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 27.9947147 | -82.5943645 | |||||||||||||||
Tampa General Hospital | Transplant | Tampa | FL | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceELITE | $91,000 | 18 | $2,200 Med/Surg | $2,850 ICU/CCU | 90% of Billed Charges | 65% of Billed Charges | Reimbursed at Invoice Cost | 55% of Billed Charges | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when the Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 27.9947147 | -82.5943645 | |||||||||||||||
Tampa General Hospital | Transplant | Tampa | FL | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | $140,000 | 20 | $2,200 Med/Surg | $3,100 ICU/CCU | 90% of Billed Charges | 65% of Billed Charges | Reimbursed at Invoice Cost | 55% of Billed Charges | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when the Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 27.9947147 | -82.5943645 | |||||||||||||||
Tampa General Hospital | Transplant | Tampa | FL | Lung | Lung | Adult | Programs of Excellence | PerformanceSELECT | Single: $120,000 | Bilateral: $130,000 | 20 | $2,200 Med/Surg | $3,100 ICU/CCU | 90% of Billed Charges | 65% of Billed Charges | Reimbursed at Invoice Cost | 55% of Billed Charges | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when the Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 27.9947147 | -82.5943645 | |||||||||||||||
UF Health Shands Hospital | Transplant | Gainesville | FL | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | $215,428 | N/A | N/A | 90% of Billed Charges | 80% of Billed Charges | 75% of Billed Charges | 100% of Billed Charges | Charges in Excess of $343,403 Shall be Reimbursed at 68% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 29.6864012 | -82.3897859 | ||||||||||||||||
UF Health Shands Hospital | Transplant | Gainesville | FL | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | $247,419 | N/A | N/A | 90% of Billed Charges | 80% of Billed Charges | 75% of Billed Charges | 100% of Billed Charges | Charges in Excess of $418,056 Shall be Reimbursed at 68% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 29.6864012 | -82.3897859 | ||||||||||||||||
UF Health Shands Hospital | Transplant | Gainesville | FL | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | Breast Cancer: $149,305 | Non-Breast Cancer: $181,659 | N/A | N/A | 90% of Billed Charges | 80% of Billed Charges | 75% of Billed Charges | 100% of Billed Charges | Charges in Excess of $275,147 (Breast Cancer) or $324,203 (Non-Breast Cancer), Shall be Reimbursed at 68% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 29.6864012 | -82.3897859 | ||||||||||||||||
UF Health Shands Hospital | Transplant | Gainesville | FL | Heart | Heart | Adult | Member's Choice | $279,415 | N/A | N/A | 90% of Billed Charges | 80% of Billed Charges | 100% of Billed Charges | 80% of Billed Charges | Charges in Excess of $439,385 Shall be Reimbursed at 68% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.6864012 | -82.3897859 | ||||||||||||||||
UF Health Shands Hospital | Transplant | Gainesville | FL | Kidney | Kidney | Adult | Member's Choice | Cadaveric Donor: $89,581 | Living Donor: $81,052 | N/A | N/A | 90% of Billed Charges | 80% of Billed Charges | Cadaveric Donor: 100% of Billed Charges | Living Donor: 75% of Billed Charge | 80% of Billed Charges | Charges in Excess of $157,835 (Cadaveric) or $147,174 (Living Donor) Shall be Reimbursed at 68% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.6864012 | -82.3897859 | ||||||||||||||||
UF Health Shands Hospital | Transplant | Gainesville | FL | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceSELECT | $155,704 | N/A | N/A | 90% of Billed Charges | 80% of Billed Charges | Cadaveric Donor: 100% of Billed Charges | Living Donor: 75% of Billed Charge | 80% of Billed Charges | Charges in Excess of $268,747, Shall be Reimbursed at 68% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.6864012 | -82.3897859 | |||||||||||||||
UF Health Shands Hospital | Transplant | Gainesville | FL | Liver | Liver | Adult | Member's Choice | Cadaveric Donor: $230,358 | Living Donor: $211,159 | N/A | N/A | 90% of Billed Charges | 80% of Billed Charges | Cadaveric Donor: 100% of Billed Charges | Living Donor: 75% of Billed Charge | 80% of Billed Charges | Charges in Excess of $377,531 (Cadaveric) or $358,333 (Living Donor), Shall be Reimbursed at 68% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.6864012 | -82.3897859 | ||||||||||||||||
UF Health Shands Hospital | Transplant | Gainesville | FL | Lung | Lung | Adult | Programs of Excellence | PerformanceELITE | Single: $181,297 | Bilateral: $209,027 | N/A | N/A | 90% of Billed Charges | 80% of Billed Charges | Cadaveric Donor 100% of Billed Charges | 80% of Billed Charges | Charges in Excess of $319,940 (Single Lung) or $371,1287 (Bilateral Lung), Shall be Reimbursed at 68% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.6864012 | -82.3897859 | |||||||||||||||
UF Health Shands Hospital | Transplant | Gainesville | FL | Liver | Liver | Pediatric | Member's Choice | $277,280 | N/A | N/A | 90% of Billed Charges | 80% of Billed Charges | Cadaveric Donor: 100% of Billed Charges | Living Donor: 75% of Billed Charge | 80% of Billed Charges | Charges in Excess of $473,508 Shall be Reimbursed at 68% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.6864012 | -82.3897859 | ||||||||||||||||
University of Miami Hospital & Clinics | Transplant | Miami | FL | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $191,589 | Professional: 70% of Billed Charges | 50 | $4,338 | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admittance for Preparative Therapy and Ends when the Number of Inlier Days have Expired | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | |||||||||||||||
University of Miami Hospital & Clinics | Transplant | Miami | FL | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $239,639 | Professional: 70% of Billed Charges | 45 | $4,338 | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admittance for Preparative Therapy and Ends when the Number of Inlier Days have Expired | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | |||||||||||||||
University of Miami Hospital & Clinics | Transplant | Miami | FL | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $102,957 | Professional: 70% of Billed Charges | 30 | $4,338 | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admittance for Preparative Therapy and Ends when the Number of Inlier Days have Expired | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | |||||||||||||||
University of Miami Hospital & Clinics | Transplant | Miami | FL | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $173,056 | Professional: 70% of Billed Charges | 30 Days (Each Transplant) | $4,338 | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admittance for Preparative Therapy and Ends when the Number of Inlier Days have Expired | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | |||||||||||||||
University of Miami Hospital & Clinics | Transplant | Miami | FL | Blood/Marrow (Tandem Auto to Related Allo) | Tandem Auto to Allo | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $269,318 | Professional: 70% of Billed Charges | 45 Days (Each Transplant) | $4,338 | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admittance for Preparative Therapy and Ends when the Number of Inlier Days have Expired | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | |||||||||||||||
University of Miami Hospital & Clinics | Transplant | Miami | FL | Blood/Marrow (Tandem Auto to Unrelated Allo) | Tandem Auto to Allo | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $323,398 | Professional: 70% of Billed Charges | 50 Days (Each Transplant) | $4,338 | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admittance for Preparative Therapy and Ends when the Number of Inlier Days have Expired | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | |||||||||||||||
Northside Hospital | Transplant | Atlanta | GA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceELITE | $135,000 | 90 | $2,000 Med/Surg | $2,000 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 33.7678358 | -84.4906438 | |||||||||||||||
Northside Hospital | Transplant | Atlanta | GA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceELITE | $165,000 | 90 | $2,000 Med/Surg | $2,000 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 33.7678358 | -84.4906438 | |||||||||||||||
Northside Hospital | Transplant | Atlanta | GA | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceELITE | $90,000 | 50 | $2,000 Med/Surg | $2,000 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 33.7678358 | -84.4906438 | |||||||||||||||
Northside Hospital | Transplant | Atlanta | GA | Blood/Marrow (Tandem Auto to Allo) | Tandem Auto to Allo | Adult | Programs of Excellence | PerformanceELITE | $190,000 | 90 from 2nd Transplant | $2,000 Med/Surg | $2,000 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 33.7678358 | -84.4906438 | |||||||||||||||
Northside Hospital | Transplant | Atlanta | GA | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Adult | Programs of Excellence | PerformanceELITE | $145,000 | 50 from 2nd Transplant | $2,000 Med/Surg | $2,000 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 33.7678358 | -84.4906438 | |||||||||||||||
University of Iowa Hospitals and Clinics | Transplant | Iowa City | IA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | $140,000 | 32 | $4,000 Med/Surg | $4,000 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.6471118 | -91.5743828 | |||||||||||||||
University of Iowa Hospitals and Clinics | Transplant | Iowa City | IA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceQUALITY | $177,000 | 35 | $4,000 Med/Surg | $4,000 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.6471118 | -91.5743828 | |||||||||||||||
University of Iowa Hospitals and Clinics | Transplant | Iowa City | IA | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceQUALITY | $112,000 | 28 | $4,000 Med/Surg | $4,000 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.6471118 | -91.5743828 | |||||||||||||||
University of Iowa Hospitals and Clinics | Transplant | Iowa City | IA | Heart | Heart | Adult | Member's Choice | $158,000 | 18 | $4,000 Med/Surg | $4,000 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | 60% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.6471118 | -91.5743828 | ||||||||||||||||
University of Iowa Hospitals and Clinics | Transplant | Iowa City | IA | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | Cadaveric Donor: $75,000 | Living Donor: $73,000 | 7 | $4,000 Med/Surg | $4,000 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | 60% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.6471118 | -91.5743828 | |||||||||||||||
University of Iowa Hospitals and Clinics | Transplant | Iowa City | IA | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceSELECT | $125,000 | 9 | $4,000 Med/Surg | $4,000 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | 60% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.6471118 | -91.5743828 | |||||||||||||||
University of Iowa Hospitals and Clinics | Transplant | Iowa City | IA | Liver | Liver | Adult | Member's Choice | Cadaveric Donor: $158,000 | Living Donor: $ 165,000 | 18 | 20 | $4,000 Med/Surg | $4,000 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | 60% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.6471118 | -91.5743828 | ||||||||||||||||
University of Iowa Hospitals and Clinics | Transplant | Iowa City | IA | Pancreas | Pancreas | Adult | Member's Choice | $90,000 | 7 | $4,000 Med/Surg | $4,000 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | 60% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.6471118 | -91.5743828 | ||||||||||||||||
University of Iowa Hospitals and Clinics | Transplant | Iowa City | IA | Heart | Heart | Pediatric | Programs of Excellence | $158,000 | 18 | $4,000 Med/Surg | $4,000 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | 60% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.6471118 | -91.5743828 | ||||||||||||||||
University of Iowa Hospitals and Clinics | Transplant | Iowa City | IA | Kidney | Kidney | Pediatric | Member's Choice | Cadaveric Donor: $75,000 | Living Donor: $73,000 | 7 | $4,000 Med/Surg | $4,000 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | 60% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.6471118 | -91.5743828 | ||||||||||||||||
University of Iowa Hospitals and Clinics | Transplant | Iowa City | IA | Kidney/Pancreas | Kidney/Pancreas | Pediatric | Member's Choice | $125,000 | 9 | $4,000 Med/Surg | $4,000 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | 60% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.6471118 | -91.5743828 | ||||||||||||||||
University of Iowa Hospitals and Clinics | Transplant | Iowa City | IA | Liver | Liver | Pediatric | Member's Choice | Cadaveric Donor: $158,000 | Living Donor: $ 165,000 | 18 | 20 | $4,000 Med/Surg | $4,000 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | 60% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.6471118 | -91.5743828 | ||||||||||||||||
Advocate Christ Medical Center | Transplant | Oak Lawn | IL | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | $198,000 | 30 | $4,000 Med/Surg | $5,000 ICU/CCU | 75% of Billed Charges | 65% of Billed Charges | Included in Case Rate | Included in Case Rate | If Charges Exceed $396,000, Then Payment will be the Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 180 Days After Discharge | 41.7091132 | -87.7770616 | ||||||||||||||||
Advocate Christ Medical Center | Transplant | Oak Lawn | IL | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | $235,000 | 30 | $4,000 Med/Surg | $5,000 ICU/CCU | 75% of Billed Charges | 65% of Billed Charges | Included in Case Rate | Included in Case Rate | If Charges Exceed $470,000, Then Payment will be the Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 180 Days After Discharge | 41.7091132 | -87.7770616 | ||||||||||||||||
Advocate Christ Medical Center | Transplant | Oak Lawn | IL | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $120,000 | 12 | $4,000 Med/Surg | $5,000 ICU/CCU | 75% of Billed Charges | 65% of Billed Charges | Included in Case Rate | Included in Case Rate | If Charges Exceed $240,000, Then Payment will be the Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 180 Days After Discharge | 41.7091132 | -87.7770616 | ||||||||||||||||
Advocate Christ Medical Center | Transplant | Oak Lawn | IL | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Adult | Member's Choice | $194,000 | 15 | $4,000 Med/Surg | $5,000 ICU/CCU | 75% of Billed Charges | 65% of Billed Charges | Included in Case Rate | Included in Case Rate | If Charges Exceed $388,000, Then Payment will be the Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 180 Days After Discharge | 41.7091132 | -87.7770616 | ||||||||||||||||
Advocate Christ Medical Center | Transplant | Oak Lawn | IL | Heart | Heart | Adult | Programs of Excellence | PerformanceSELECT | $235,000 | 18 | $4,000 Med/Surg | $5,000 ICU/CCU | 75% of Billed Charges | 65% of Billed Charges | Included in Case Rate | 50% of Billed Charges | If Charges Exceed $470,000, Then Payment will be the Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 180 Days After Discharge | 41.7091132 | -87.7770616 | |||||||||||||||
Advocate Christ Medical Center | Transplant | Oak Lawn | IL | Kidney | Kidney | Adult | Member's Choice | Cadaveric Donor: $95,000 | Living Donor: $99,000 | 12 | $4,000 Med/Surg | $5,000 ICU/CCU | 75% of Billed Charges | 65% of Billed Charges | Included in Case Rate | 50% of Billed Charges | If Charges Exceed $190,000 (Cadaveric) or 198,000 (Living), Then Payment will be the Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 180 Days After Discharge | 41.7091132 | -87.7770616 | ||||||||||||||||
Advocate Christ Medical Center | Transplant | Oak Lawn | IL | Lung | Lung | Adult | Member's Choice | Single: $195,000 | Bilateral: $285,000 | 20 | $4,000 Med/Surg | $5,000 ICU/CCU | 75% of Billed Charges | 65% of Billed Charges | Included in Case Rate | 50% of Billed Charges | If Charges Exceed $195,000 (Single) or $570,000 (Bilateral), Then Payment will be the Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 180 Days After Discharge | 41.7091132 | -87.7770616 | ||||||||||||||||
Ann & Robert H Lurie Children's Hospital of Chicago | Transplant | Chicago | IL | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $140,000 | 30 | $1,800 Med/Surg | $2,400 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | ||||||||||||||||
Ann & Robert H Lurie Children's Hospital of Chicago | Transplant | Chicago | IL | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $160,000 | 40 | $1,800 Med/Surg | $2,400 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | ||||||||||||||||
Ann & Robert H Lurie Children's Hospital of Chicago | Transplant | Chicago | IL | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $110,000 | 30 | $1,800 Med/Surg | $2,400 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | ||||||||||||||||
Ann & Robert H Lurie Children's Hospital of Chicago | Transplant | Chicago | IL | Blood/Marrow (Tandem) | Tandem Auto to Allo | Pediatric | Programs of Excellence | 65% of Billed Charges | 30 Days from Last Stem Cell Infusion | $1,800 Med/Surg | $2,400 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | ||||||||||||||||
Ann & Robert H Lurie Children's Hospital of Chicago | Transplant | Chicago | IL | Blood/Marrow (Tandem) | Tandem Auto to Auto | Pediatric | Programs of Excellence | 65% of Billed Charges | 30 Days from Last Stem Cell Infusion | $1,800 Med/Surg | $2,400 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | ||||||||||||||||
Ann & Robert H Lurie Children's Hospital of Chicago | Transplant | Chicago | IL | Heart | Heart | Pediatric | Programs of Excellence | $125,000 | 25 | $1,800 Med/Surg | $2,400 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | N/A | N/A | Included in Case Rate | Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days have Expired | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | ||||||||||||||
Ann & Robert H Lurie Children's Hospital of Chicago | Transplant | Chicago | IL | Intestine | Intestine | Pediatric | Member's Choice | 65% of Billed Charges | 6 Months | N/A | N/A | 75% of Billed Charges | Included in Case Rate | Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days have Expired | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | ||||||||||||||||
Ann & Robert H Lurie Children's Hospital of Chicago | Transplant | Chicago | IL | Kidney | Kidney | Pediatric | Programs of Excellence | $65,000 | 15 | $1,800 Med/Surg | $2,400 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | ||||||||||||||||
Ann & Robert H Lurie Children's Hospital of Chicago | Transplant | Chicago | IL | Liver | Liver | Pediatric | Programs of Excellence | $155,000 | 25 | $1,800 Med/Surg | $2,400 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | ||||||||||||||||
Northwestern Memorial Hospital | Transplant | Chicago | IL | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | $128,000 | 30 | $2,500 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Invoice Cost + 5% | 50% of Billed Charges | Begins at Evaluation | Beginning on Day One (1) of Ablative Therapy and Ending the Day of Discharge | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | |||||||||||||||
Northwestern Memorial Hospital | Transplant | Chicago | IL | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceQUALITY | $148,000 | 40 | $2,500 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Invoice Cost + 5% | 50% of Billed Charges | Begins at Evaluation | Beginning on Day One (1) of Ablative Therapy and Ending the Day of Discharge | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | |||||||||||||||
Northwestern Memorial Hospital | Transplant | Chicago | IL | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceQUALITY | $90,000 | 25 | $2,500 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Invoice Cost + 5% | 50% of Billed Charges | Begins at Evaluation | Beginning on Day One (1) of Ablative Therapy and Ending the Day of Discharge | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | |||||||||||||||
Northwestern Memorial Hospital | Transplant | Chicago | IL | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Adult | Programs of Excellence | PerformanceQUALITY | 1st: $90,000 | 2nd: $75,000 | 25 | 20 | $2,500 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Invoice Cost + 5% | 50% of Billed Charges | Begins at Evaluation | Beginning on Day One (1) of Ablative Therapy and Ending the Day of Discharge | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | |||||||||||||||
Northwestern Memorial Hospital | Transplant | Chicago | IL | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | $240,000 | 23 | $3,200 Med/Surg | $4,000 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | |||||||||||||||
Northwestern Memorial Hospital | Transplant | Chicago | IL | Intestine | Intestine | Adult | Member's Choice | 65% of Billed Charges | N/A | N/A | N/A | 75% of Billed Charges | Included in Case Rate | Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | ||||||||||||||||
Northwestern Memorial Hospital | Transplant | Chicago | IL | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | Cadaveric Donor: $68,000 | Living Donor: $66,000 | 12 | $1,850 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | |||||||||||||||
Northwestern Memorial Hospital | Transplant | Chicago | IL | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceQUALITY | $130,000 | 22 | $1,850 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | |||||||||||||||
Northwestern Memorial Hospital | Transplant | Chicago | IL | Liver | Liver | Adult | Programs of Excellence | PerformanceSELECT | Cadaveric Donor: $145,000 | Living Donor: $155,000 | 25 | $2,500 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | |||||||||||||||
Northwestern Memorial Hospital | Transplant | Chicago | IL | Lung | Lung | Adult | Programs of Excellence | PerformanceQUALITY | $235,000 | 25 | $3,200 Med/Surg | $4,000 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | |||||||||||||||
University of Chicago Medical Center | Transplant | Chicago | IL | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | $1338,00 | 42 | 55% of Billed Charges | 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | 55% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | |||||||||||||||
University of Chicago Medical Center | Transplant | Chicago | IL | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceQUALITY | $133,800 | 42 | 55% of Billed Charges | 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | 55% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | |||||||||||||||
University of Chicago Medical Center | Transplant | Chicago | IL | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceQUALITY | $91,800 | 32 | 55% of Billed Charges | 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | 55% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | |||||||||||||||
University of Chicago Medical Center | Transplant | Chicago | IL | Heart | Heart | Adult | Programs of Excellence | PerformanceELITE | $118,000 | 25 | 55% of Billed Charges | 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | 55% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | |||||||||||||||
University of Chicago Medical Center | Transplant | Chicago | IL | Kidney | Kidney | Adult | Member's Choice | $53,000 | 15 | 55% of Billed Charges | 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | 55% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | ||||||||||||||||
University of Chicago Medical Center | Transplant | Chicago | IL | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $89,880 | 20 | 55% of Billed Charges | 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | 55% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | ||||||||||||||||
University of Chicago Medical Center | Transplant | Chicago | IL | Liver | Liver | Adult | Member's Choice | $148,000 | 33 | 55% of Billed Charges | 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | 55% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | ||||||||||||||||
University of Chicago Medical Center | Transplant | Chicago | IL | Lung | Lung | Adult | Member's Choice | Single or Bilateral: $150,000 | 20 | 55% of Billed Charges | 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | 55% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | ||||||||||||||||
University of Chicago Medical Center | Transplant | Chicago | IL | Pancreas | Pancreas | Adult | Member's Choice | $72,000 | 20 | 55% of Billed Charges | 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | 55% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.8339037 | -87.8720468 | ||||||||||||||||
Indiana Blood and Marrow Transplantation | Transplant | Indianapolis | IN | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | $110,000 | 35 | $2,000 Med/Surg | $2,500 ICU/Ccu | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.7799642 | -86.2728331 | ||||||||||||||||
Indiana Blood and Marrow Transplantation | Transplant | Indianapolis | IN | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | $140,000 | 40 | $2,000 Med/Surg | $2,500 ICU/Ccu | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.7799642 | -86.2728331 | ||||||||||||||||
Indiana Blood and Marrow Transplantation | Transplant | Indianapolis | IN | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $80,000 | 30 | $2,000 Med/Surg | $2,500 ICU/Ccu | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.7799642 | -86.2728331 | ||||||||||||||||
IUH - Indiana University Medical Center | Transplant | Indianapolis | IN | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | $178,464 | 35 | $4,002 Med/Surg/ICU/CCU | 80% of Billed Charges | Pre: 70% of Billed Charges | Post: 80% of Billed Charges | Included in Case Rate | N/A | Charges that Exceed the Stop Loss Threshold Amount ($486,720) Shall be Reimbursed at 59% | Begins at Evaluation | Begins on the Day Prior to Ablative Therapy and Ends at Discharge | Ends Ninety (90) Days Post Discharge | 39.7799642 | -86.2728331 | ||||||||||||||||
IUH - Indiana University Medical Center | Transplant | Indianapolis | IN | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | $232,544 | 40 | $4,002 Med/Surg/ICU/CCU | 80% of Billed Charges | Pre: 70% of Billed Charges | Post: 80% of Billed Charges | Included in Case Rate | N/A | Charges that Exceed the Stop Loss Threshold Amount ($529,984) Shall be Reimbursed at 59% | Begins at Evaluation | Begins on the Day Prior to Ablative Therapy and Ends at Discharge | Ends Ninety (90) Days Post Discharge | 39.7799642 | -86.2728331 | ||||||||||||||||
IUH - Indiana University Medical Center | Transplant | Indianapolis | IN | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $137,363 | 20 | $4,002 Med/Surg/ICU/CCU | 80% of Billed Charges | Pre: 70% of Billed Charges | Post: 80% of Billed Charges | Included in Case Rate | N/A | Charges that Exceed the Stop Loss Threshold Amount ($274,726) Shall be Reimbursed at 59% | Begins at Evaluation | Begins on the Day Prior to Ablative Therapy and Ends at Discharge | Ends Ninety (90) Days Post Discharge | 39.7799642 | -86.2728331 | ||||||||||||||||
IUH - Indiana University Medical Center | Transplant | Indianapolis | IN | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Adult | Member's Choice | 1st: $131,995 | 2nd: $108,160 | 20 | 20 | $4,002 Med/Surg/ICU/CCU | 80% of Billed Charges | Pre: 70% of Billed Charges | Post: 80% of Billed Charges | Included in Case Rate | N/A | Charges that Exceed the Stop Loss Threshold Amount (1st: $263,910; 2nd: $216,320) Shall be Reimbursed at 59% | Begins at Evaluation | Begins on the Day Prior to Ablative Therapy and Ends at Discharge | Ends Ninety (90) Days Post Discharge | 39.7799642 | -86.2728331 | ||||||||||||||||
IUH - Indiana University Medical Center | Transplant | Indianapolis | IN | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | $105,997 | 12 | $4,002 Med/Surg/ICU/CCU | 80% of Billed Charges | Pre: 70% of Billed Charges | Post: 80% of Billed Charges | Included in Case Rate | 120% of Invoice Cost if During the Transplant Inpatient Admission. If Implanted During Pre or Post Transplant Phase, Reimburse at that Provision Rate | Charges that Exceed the Stop Loss Threshold Amount ($211,994) Shall be Reimbursed at 59% | Begins at Evaluation | Begins on the Day Prior to Transplant and Ends at Discharge | Ends Ninety (90) Days Post Discharge | 39.7799642 | -86.2728331 | |||||||||||||||
IUH - Indiana University Medical Center | Transplant | Indianapolis | IN | Kidney/Liver | Kidney/Liver | Adult | Member's Choice | $251,520 | 25 | $4,002 Med/Surg/ICU/CCU | 80% of Billed Charges | Pre: 70% of Billed Charges | Post: 80% of Billed Charges | Included in Case Rate | 120% of Invoice Cost if During the Transplant Inpatient Admission. If Implanted During Pre or Post Transplant Phase, Reimburse at that Provision Rate | Charges that Exceed the Stop Loss Threshold Amount ($811,200) Shall be Reimbursed at 59% | Begins at Evaluation | Begins on the Day Prior to Transplant and Ends at Discharge | Ends Ninety (90) Days Post Discharge | 39.7799642 | -86.2728331 | ||||||||||||||||
IUH - Indiana University Medical Center | Transplant | Indianapolis | IN | Pancreas | Pancreas | Adult | Member's Choice | $138,653 | 15 | $4,002 Med/Surg/ICU/CCU | 80% of Billed Charges | Pre: 70% of Billed Charges | Post: 80% of Billed Charges | Included in Case Rate | 120% of Invoice Cost if During the Transplant Inpatient Admission. If Implanted During Pre or Post Transplant Phase, Reimburse at that Provision Rate | Charges that Exceed the Stop Loss Threshold Amount ($276,890) Shall be Reimbursed at 59% | Begins at Evaluation | Begins on the Day Prior to Transplant and Ends at Discharge | Ends Ninety (90) Days Post Discharge | 39.7799642 | -86.2728331 | ||||||||||||||||
IUH - Indiana University Medical Center | Transplant | Indianapolis | IN | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceELITE | $196,851 | 15 | $4,002 Med/Surg/ICU/CCU | 80% of Billed Charges | Pre: 70% of Billed Charges | Post: 80% of Billed Charges | Included in Case Rate | 120% of Invoice Cost if During the Transplant Inpatient Admission. If Implanted During Pre or Post Transplant Phase, Reimburse at that Provision Rate | Charges that Exceed the Stop Loss Threshold Amount ($364,000) Shall be Reimbursed at 59% | Begins at Evaluation | Begins on the Day Prior to Transplant and Ends at Discharge | Ends Ninety (90) Days Post Discharge | 39.7799642 | -86.2728331 | |||||||||||||||
IUH - Indiana University Medical Center | Transplant | Indianapolis | IN | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | $243,360 | 23 | $4,002 Med/Surg/ICU/CCU | 80% of Billed Charges | Pre: 70% of Billed Charges | Post: 80% of Billed Charges | Included in Case Rate | 120% of Invoice Cost if During the Transplant Inpatient Admission. If Implanted During Pre or Post Transplant Phase, Reimburse at that Provision Rate | Charges that Exceed the Stop Loss Threshold Amount ($486,720) Shall be Reimbursed at 59% | Begins at Evaluation | Begins on the Day Prior to Transplant and Ends at Discharge | Ends Ninety (90) Days Post Discharge | 39.7799642 | -86.2728331 | |||||||||||||||
IUH - Indiana University Medical Center | Transplant | Indianapolis | IN | Multi-Visceral | Multi-Visceral | Adult | Member's Choice | 65% of Billed Charges | N/A | N/A | N/A | Pre: 70% of Billed Charges | Post: 80% of Billed Charges | Included in Case Rate | 120% of Invoice Cost if During the Transplant Inpatient Admission. If Implanted During Pre or Post Transplant Phase, Reimburse at that Provision Rate | N/A | Begins at Evaluation | Begins on the Day Prior to Transplant and Ends at Discharge | Ends Ninety (90) Days Post Discharge | 39.7799642 | -86.2728331 | ||||||||||||||||
IUH - Indiana University Medical Center | Transplant | Indianapolis | IN | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | $237,952 | 22 | $4,002 Med/Surg/ICU/CCU | 80% of Billed Charges | Pre: 70% of Billed Charges | Post: 80% of Billed Charges | Included in Case Rate | 120% of Invoice Cost if During the Transplant Inpatient Admission. If Implanted During Pre or Post Transplant Phase, Reimburse at that Provision Rate | Charges that Exceed the Stop Loss Threshold Amount ($584,064) Shall be Reimbursed at 59% | Begins at Evaluation | Begins on the Day Prior to Transplant and Ends at Discharge | Ends Ninety (90) Days Post Discharge | 39.7799642 | -86.2728331 | |||||||||||||||
IUH - Indiana University Medical Center | Transplant | Indianapolis | IN | Lung | Lung | Adult | Programs of Excellence | PerformanceQUALITY | Single: $156,832 | Bilateral: $237,952 | 20 | 25 | $4,002 Med/Surg/ICU/CCU | 80% of Billed Charges | Pre: 70% of Billed Charges | Post: 80% of Billed Charges | Included in Case Rate | 120% of Invoice Cost if During the Transplant Inpatient Admission. If Implanted During Pre or Post Transplant Phase, Reimburse at that Provision Rate | Charges that Exceed the Stop Loss Threshold Amount (Single: $454,272; Double: $555,942) Shall be Reimbursed at 59% | Begins at Evaluation | Begins on the Day Prior to Transplant and Ends at Discharge | Ends Ninety (90) Days Post Discharge | 39.7799642 | -86.2728331 | |||||||||||||||
IUH - Riley Hospital for Children | Transplant | Indianapolis | IN | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $194,688 | 35 | $4,002 Med/Surg/ICU/CCU | 80% of Billed Charges | Pre: 70% of Billed Charges | Post: 80% of Billed Charges | Included in Case Rate | N/A | Charges that Exceed the Stop Loss Threshold Amount ($513,760) Shall be Reimbursed at 59% | Begins at Evaluation | Begins on the Day Prior to Ablative Therapy and Ends at Discharge | Ends Ninety (90) Days Post Discharge | 39.7799642 | -86.2728331 | ||||||||||||||||
IUH - Riley Hospital for Children | Transplant | Indianapolis | IN | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $270,400 | 40 | $4,002 Med/Surg/ICU/CCU | 80% of Billed Charges | Pre: 70% of Billed Charges | Post: 80% of Billed Charges | Included in Case Rate | N/A | Charges that Exceed the Stop Loss Threshold Amount ($568,922) Shall be Reimbursed at 59% | Begins at Evaluation | Begins on the Day Prior to Ablative Therapy and Ends at Discharge | Ends Ninety (90) Days Post Discharge | 39.7799642 | -86.2728331 | ||||||||||||||||
IUH - Riley Hospital for Children | Transplant | Indianapolis | IN | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $179,546 | 20 | $4,002 Med/Surg/ICU/CCU | 80% of Billed Charges | Pre: 70% of Billed Charges | Post: 80% of Billed Charges | Included in Case Rate | N/A | Charges that Exceed the Stop Loss Threshold Amount ($359,091) Shall be Reimbursed at 59% | Begins at Evaluation | Begins on the Day Prior to Ablative Therapy and Ends at Discharge | Ends Ninety (90) Days Post Discharge | 39.7799642 | -86.2728331 | ||||||||||||||||
IUH - Riley Hospital for Children | Transplant | Indianapolis | IN | Heart | Heart | Pediatric | Member's Choice | $254,176 | 22 | $4,002 Med/Surg/ICU/CCU | 80% of Billed Charges | Pre: 70% of Billed Charges | Post: 80% of Billed Charges | Included in Case Rate | 120% of Invoice Cost if During the Transplant Inpatient Admission. If Implanted During Pre or Post Transplant Phase, Reimburse at that Provision Rate | Charges that Exceed the Stop Loss Threshold Amount ($627,328) Shall be Reimbursed at 59% | Begins at Evaluation | Begins on the Day Prior to Transplant and Ends at Discharge | Ends Ninety (90) Days Post Discharge | 39.7799642 | -86.2728331 | ||||||||||||||||
IUH - Riley Hospital for Children | Transplant | Indianapolis | IN | Kidney | Kidney | Pediatric | Programs of Excellence | $120,058 | 12 | $4,002 Med/Surg/ICU/CCU | 80% of Billed Charges | Pre: 70% of Billed Charges | Post: 80% of Billed Charges | Included in Case Rate | 120% of Invoice Cost if During the Transplant Inpatient Admission. If Implanted During Pre or Post Transplant Phase, Reimburse at that Provision Rate | Charges that Exceed the Stop Loss Threshold Amount ($240,115) Shall be Reimbursed at 59% | Begins at Evaluation | Begins on the Day Prior to Transplant and Ends at Discharge | Ends Ninety (90) Days Post Discharge | 39.7799642 | -86.2728331 | ||||||||||||||||
IUH - Riley Hospital for Children | Transplant | Indianapolis | IN | Liver | Liver | Pediatric | Programs of Excellence | $297,440 | 23 | $4,002 Med/Surg/ICU/CCU | 80% of Billed Charges | Pre: 70% of Billed Charges | Post: 80% of Billed Charges | Included in Case Rate | 120% of Invoice Cost if During the Transplant Inpatient Admission. If Implanted During Pre or Post Transplant Phase, Reimburse at that Provision Rate | Charges that Exceed the Stop Loss Threshold Amount ($594,880) Shall be Reimbursed at 59% | Begins at Evaluation | Begins on the Day Prior to Transplant and Ends at Discharge | Ends Ninety (90) Days Post Discharge | 39.7799642 | -86.2728331 | ||||||||||||||||
IUH - Riley Hospital for Children | Transplant | Indianapolis | IN | Multi-Visceral | Multi-Visceral | Pediatric | Member's Choice | 65% of Billed Charges | N/A | N/A | N/A | Pre: 70% of Billed Charges | Post: 80% of Billed Charges | Included in Case Rate | 120% of Invoice Cost if During the Transplant Inpatient Admission. If Implanted During Pre or Post Transplant Phase, Reimburse at that Provision Rate | N/A | Begins at Evaluation | Begins on the Day Prior to Transplant and Ends at Discharge | Ends Ninety (90) Days Post Discharge | 39.7799642 | -86.2728331 | ||||||||||||||||
Jewish Hospital | Transplant | Louisville | KY | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $72,000 | Physicians Group: 80% of Billed Charges | Anesthesia Physicians: 70% of Billed Charges | 10 | Hospital: $2,100 Med/Surg; $3,000 ICU/CCU | Physicians: Same as Case Rate | Hospital: 75% of Billed Charges | Physicians: Same as Case Rate | Hospital: 70% of Billed Charges | Physicians: Same as Case Rate | Included in Case Rate | Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 38.1889916 | -85.8168537 | |||||||||||||||
Jewish Hospital | Transplant | Louisville | KY | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | Hospital: $62,000 | Physicians Group: 80% of Billed Charges | Anesthesia Physicians: 70% of Billed Charges | 10 | Hospital: $2,100 Med/Surg; $3,000 ICU/CCU | Physicians: Same as Case Rate | Hospital: 75% of Billed Charges | Physicians: Same as Case Rate | Hospital: 70% of Billed Charges | Physicians: Same as Case Rate | Included in Case Rate | Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 38.1889916 | -85.8168537 | ||||||||||||||||
Jewish Hospital | Transplant | Louisville | KY | Liver | Liver | Adult | Member's Choice | Hospital (Cadaveric Donor): $138,000 | Hospital (Living Donor): $148,000 | Physicians Group: 80% of Billed Charges| Anesthesia Physicians: 70% of Billed Charges | 18 | Hospital: $2,100 Med/Surg; $3,000 ICU/CCU | Physicians: Same as Case Rate | Hospital: 75% of Billed Charges | Physicians: Same as Case Rate | Hospital: 70% of Billed Charges | Physicians: Same as Case Rate | Included in Case Rate | Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 38.1889916 | -85.8168537 | ||||||||||||||||
Jewish Hospital | Transplant | Louisville | KY | Lung | Lung | Adult | Member's Choice | Hospital (Single Lung): $126,000 | Hospital (Bilateral Lung): $136,000 | Physicians Group: 80% of Billed Charges | Anesthesia Physicians: 70% of Billed Charges | 21 | Hospital: $2,100 Med/Surg; $3,000 ICU/CCU | Physicians: Same as Case Rate | Hospital: 75% of Billed Charges | Physicians: Same as Case Rate | Hospital: 70% of Billed Charges | Physicians: Same as Case Rate | Included in Case Rate | Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 38.1889916 | -85.8168537 | ||||||||||||||||
University of Kentucky Medical Center | Transplant | Lexington | KY | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | $159,135 | 35 | $2,758 Med/Surg | $3,183 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | 55% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 38.0285173 | -84.6116483 | |||||||||||||||
University of Kentucky Medical Center | Transplant | Lexington | KY | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceQUALITY | $201,571 | 35 | $2,758 Med/Surg | $3,183 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | 55% of Billed Charges | 55% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 38.0285173 | -84.6116483 | |||||||||||||||
University of Kentucky Medical Center | Transplant | Lexington | KY | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceQUALITY | $101,846 | 25 | $2,758 Med/Surg | $3,183 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 38.0285173 | -84.6116483 | ||||||||||||||||
University of Kentucky Medical Center | Transplant | Lexington | KY | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | $180,353 | 18 | $2,758 Med/Surg | $3,183 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | 55% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 38.0285173 | -84.6116483 | |||||||||||||||
University of Kentucky Medical Center | Transplant | Lexington | KY | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | Cadaveric Donor: $100,786 | Living Donor: $84,872 | 12 | $2,758 Med/Surg | $3,183 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 38.0285173 | -84.6116483 | |||||||||||||||
University of Kentucky Medical Center | Transplant | Lexington | KY | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $125,186 | 15 | $2,758 Med/Surg | $3,183 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 38.0285173 | -84.6116483 | ||||||||||||||||
University of Kentucky Medical Center | Transplant | Lexington | KY | Liver | Liver | Adult | Member's Choice | Cadaveric Donor: $203,693 | Living Donor: $214,302 | 20 | $2,758 Med/Surg | $3,183 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 38.0285173 | -84.6116483 | ||||||||||||||||
University of Kentucky Medical Center | Transplant | Lexington | KY | Lung | Lung | Adult | Member's Choice | Single: $175,049 | Bilateral: $196,267 | 20 | 21 | $2,758 Med/Surg | $3,183 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 38.0285173 | -84.6116483 | ||||||||||||||||
University of Kentucky Medical Center | Transplant | Lexington | KY | Pancreas | Pancreas | Adult | Member's Choice | $93,259 | 18 | $2,758 Med/Surg | $3,183 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 38.0285173 | -84.6116483 | ||||||||||||||||
Ochsner Foundation Hospital | Transplant | Jefferson | LA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | $125,000 | 30 | $2,300 Med/Surg | $3,300 ICU/CCU | 80% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | If Billed Charges Exceed 1.5 Times the Case Rate (Plus Applicable Per Diems), Payment will be the Transplant Case Rate, Plus 50% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.958954 | -90.185577 | ||||||||||||||||
Ochsner Foundation Hospital | Transplant | Jefferson | LA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | $150,000 | 35 | $2,300 Med/Surg | $3,300 ICU/CCU | 80% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | If Billed Charges Exceed 1.5 Times the Case Rate (Plus Applicable Per Diems), Payment will be the Transplant Case Rate, Plus 50% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.958954 | -90.185577 | ||||||||||||||||
Ochsner Foundation Hospital | Transplant | Jefferson | LA | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $98,000 | 25 | $2,300 Med/Surg | $3,300 ICU/CCU | 80% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | If Billed Charges Exceed 1.5 Times the Case Rate (Plus Applicable Per Diems), Payment will be the Transplant Case Rate, Plus 50% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.958954 | -90.185577 | ||||||||||||||||
Ochsner Foundation Hospital | Transplant | Jefferson | LA | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Adult | Member's Choice | 1st Transplant: $98,000 | 2nd Transplant: $77,000 | 30 | 20 | $2,300 Med/Surg | $3,300 ICU/CCU | 80% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | If Billed Charges Exceed 1.5 Times the Case Rate (Plus Applicable Per Diems), Payment will be the Transplant Case Rate, Plus 50% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.958954 | -90.185577 | ||||||||||||||||
Ochsner Foundation Hospital | Transplant | Jefferson | LA | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | $187,079 | N/A | N/A | 80% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 75% of Billed Charges | If Billed Charges Exceed $299,327, Payment will be the Transplant Case Rate, Plus 50% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.958954 | -90.185577 | |||||||||||||||
Ochsner Foundation Hospital | Transplant | Jefferson | LA | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | $88,242 | N/A | N/A | 80% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 75% of Billed Charges | If Billed Charges Exceed $141,187, Payment will be the Transplant Case Rate, Plus 50% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.958954 | -90.185577 | |||||||||||||||
Ochsner Foundation Hospital | Transplant | Jefferson | LA | Kidney/Liver | Kidney/Liver | Adult | Member's Choice | $266,630 | N/A | N/A | 80% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 75% of Billed Charges | If Billed Charges Exceed $426,608, Payment will be the Transplant Case Rate, Plus 50% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.958954 | -90.185577 | ||||||||||||||||
Ochsner Foundation Hospital | Transplant | Jefferson | LA | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceELITE | $146,012 | N/A | N/A | 80% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 75% of Billed Charges | If Billed Charges Exceed $233,619, Payment will be the Transplant Case Rate, Plus 50% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.958954 | -90.185577 | |||||||||||||||
Ochsner Foundation Hospital | Transplant | Jefferson | LA | Liver | Liver | Adult | Programs of Excellence | PerformanceELITE | $221,911 | N/A | N/A | 80% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 75% of Billed Charges | If Billed Charges Exceed 355,05800, Payment will be the Transplant Case Rate, Plus 50% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.958954 | -90.185577 | |||||||||||||||
Ochsner Foundation Hospital | Transplant | Jefferson | LA | Lung | Lung | Adult | Member's Choice | $210,675 | N/A | N/A | 80% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 75% of Billed Charges | If Billed Charges Exceed 337,800, Payment will be the Transplant Case Rate, Plus 50% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.958954 | -90.185577 | ||||||||||||||||
Baystate Medical Center | Transplant | Springfield | MA | Kidney | Kidney | Adult | Member's Choice | Cadaveric Donor: $38,360 | Living Donor: $89,600 | 10 | Cadaveric: $3,640 Med/Surg; $4,480 ICU/CCU | Living: $2,968 Med/Surg; $4,480 ICU/CCU | 85% of Billed Charges | 67.47% of Billed Charges | Cadaveric: 100% of Invoice Cost | Living: Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 42.1128988 | -72.5813608 | ||||||||||||||||
Beth Israel Deaconess Medical Center | Transplant | Boston | MA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | Hospital: $127,196 | Professional: $15,804 | 40 | 80% of Billed Charges | 85% of Billed Charges | 65% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | ||||||||||||||||
Beth Israel Deaconess Medical Center | Transplant | Boston | MA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | Hospital: $160,092 | Professional $15,908 | 42 | 80% of Billed Charges | 85% of Billed Charges | 65% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | ||||||||||||||||
Beth Israel Deaconess Medical Center | Transplant | Boston | MA | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | Hospital: $86,196 | Professional: $12,804 | 30 | 80% of Billed Charges | 85% of Billed Charges | 65% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | ||||||||||||||||
Beth Israel Deaconess Medical Center | Transplant | Boston | MA | Kidney | Kidney | Adult | Member's Choice | Hospital (Cadaveric Donor): $69,235 | Physicians (Cadaveric Donor): $5,765 | Hospital (Living Donor): $60,958 | Physicians (Living Donor): $12,042 | 12 | 80% of Billed Charges | 85% of Billed Charges | 65% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | ||||||||||||||||
Beth Israel Deaconess Medical Center | Transplant | Boston | MA | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | Hospital: $156,140 | Professional: $18,860 | 18 | 80% of Billed Charges | 85% of Billed Charges | 65% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | ||||||||||||||||
Beth Israel Deaconess Medical Center | Transplant | Boston | MA | Liver | Liver | Adult | Programs of Excellence | PerformanceELITE | Hospital (Cadaveric Donor): $151,511 | Physicians (Cadaveric Donor): $17,489 | Hospital (Living Donor): $142,589 | Physicians (Living Donor): $42,411 | 21 | 80% of Billed Charges | 85% of Billed Charges | 65% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | |||||||||||||||
Beth Israel Deaconess Medical Center | Transplant | Boston | MA | Pancreas | Pancreas | Adult | Member's Choice | Hospital: $108,820 | Professional: $10,180 | 15 | 80% of Billed Charges | 85% of Billed Charges | 65% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | ||||||||||||||||
Boston Children's Hospital | Transplant | Boston | MA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | Hospital: $185,000 | Professional: 85% of Billed Charges | 40 | Hospital: $4,000 | Professional: 85% of Billed Charges | 95% of Billed Charges | 85% of Billed Charges | Included in Case Rate | 100% of Invoice Cost | 80% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | ||||||||||||||||
Boston Children's Hospital | Transplant | Boston | MA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | Hospital: $195,000 | Professional: 85% of Billed Charges | 40 | Hospital: $4,000 | Professional: 85% of Billed Charges | 95% of Billed Charges | 85% of Billed Charges | Included in Case Rate | 100% of Invoice Cost | 80% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | ||||||||||||||||
Boston Children's Hospital | Transplant | Boston | MA | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | Hospital: $160,000 | Professional: 85% of Billed Charges | 40 | Hospital: $4,000 | Professional: 85% of Billed Charges | 95% of Billed Charges | 85% of Billed Charges | Included in Case Rate | 100% of Invoice Cost | 80% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | ||||||||||||||||
Boston Children's Hospital | Transplant | Boston | MA | Heart | Heart | Pediatric | Programs of Excellence | Hospital: $175,000 | Professional: 85% of Billed Charges | 30 | Hospital: $4,000 | Professional: 85% of Billed Charges | 95% of Billed Charges | 85% of Billed Charges | Included in Case Rate | N/A | 80% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | ||||||||||||||||
Boston Children's Hospital | Transplant | Boston | MA | Kidney | Kidney | Pediatric | Programs of Excellence | Hospital: $80,000 | Professional: 85% of Billed Charges | 12 | Hospital: $4,000 | Professional: 85% of Billed Charges | 95% of Billed Charges | 85% of Billed Charges | Included in Case Rate | N/A | 80% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | ||||||||||||||||
Boston Children's Hospital | Transplant | Boston | MA | Liver | Liver | Pediatric | Member's Choice | Hospital: $180,000 | Professional: 85% of Billed Charges | 35 | Hospital: $4,000 | Professional: 85% of Billed Charges | 95% of Billed Charges | 85% of Billed Charges | Included in Case Rate | N/A | 80% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | ||||||||||||||||
Boston Children's Hospital | Transplant | Boston | MA | Lung | Lung | Pediatric | Programs of Excellence | Hospital: $180,000 | Professional: 85% of Billed Charges | 25 | Hospital: $4,000 | Professional: 85% of Billed Charges | 95% of Billed Charges | 85% of Billed Charges | Included in Case Rate | N/A | 80% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | ||||||||||||||||
Brigham and Women's Hospital | Transplant | Boston | MA | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $155,000 | Professional: 80% of Billed Charges | 22 | N/A | N/A | 80% of Billed Charges | Included in Case Rate | N/A | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | |||||||||||||||
Brigham and Women's Hospital | Transplant | Boston | MA | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $150,000 | Professional: 80% of Billed Charges | 20 | N/A | N/A | 80% of Billed Charges | Included in Case Rate | N/A | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | |||||||||||||||
Brigham and Women's Hospital | Transplant | Boston | MA | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | Hospital Cadaveric Donor: $67,800 | Hospital Living Donor: $62,500 | Professional: 80% of Billed Charges | Living: 15 | Cadaveric: 12 | $2,260 Med/Surg | $2,920 ICU/CCU | 90% of Billed Charges for hospital | 80% of Billed Charges | Included in Case Rate | N/A | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | |||||||||||||||
Brigham and Women's Hospital | Transplant | Boston | MA | Lung | Lung | Adult | Programs of Excellence | PerformanceSELECT | Hospital (Single Lung): $140,000 | Hospital (Bilateral Lung): $175,000 | Physicians: 80% of Billed Charges | 25 | $2,260 Med/Surg | $2,920 ICU/CCU | 90% of Billed Charges for hospital | 80% of Billed Charges | Included in Case Rate | N/A | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | |||||||||||||||
Dana-Farber Cancer Institute | Transplant | Boston | MA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceELITE | Hospital: $125,000 | Professional: 80% of Billed Charges | 40 | $2,260 Med/Surg | $2,920 ICU/CCU | 90% of Billed Charges for hospital | 80% of Billed Charges | Included in Case Rate | 80% of Billed Charges | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | |||||||||||||||
Dana-Farber Cancer Institute | Transplant | Boston | MA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceELITE | Hospital: $155,000 | Professional: 80% of Billed Charges | 45 | $2,260 Med/Surg | $2,920 ICU/CCU | 90% of Billed Charges for hospital | 80% of Billed Charges | Included in Case Rate | 80% of Billed Charges | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | |||||||||||||||
Dana-Farber Cancer Institute | Transplant | Boston | MA | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceELITE | Hospital: $100,000 | Professional: 80% of Billed Charges | 30 | $2,260 Med/Surg | $2,920 ICU/CCU | 90% of Billed Charges for hospital | 80% of Billed Charges | Included in Case Rate | 80% of Billed Charges | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | |||||||||||||||
Lahey Clinic Medical Center | Transplant | Burlington | MA | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $100,000 | 30 | 70% of Billed Charges | 95% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 42.5051924 | -71.23983 | ||||||||||||||||
Lahey Clinic Medical Center | Transplant | Burlington | MA | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | Cadaveric: $75,000 | Living: $70,000 | 12 | 70% of Billed Charges | 95% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 42.5051924 | -71.23983 | |||||||||||||||
Lahey Clinic Medical Center | Transplant | Burlington | MA | Kidney/Liver | Kidney/Liver | Adult | Member's Choice | $205,000 | 25 | 70% of Billed Charges | 95% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 42.5051924 | -71.23983 | ||||||||||||||||
Lahey Clinic Medical Center | Transplant | Burlington | MA | Liver | Liver | Adult | Programs of Excellence | PerformanceSELECT | Cadaveric: $170,000 | Living: $180,000 | 20 | 70% of Billed Charges | 95% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 42.5051924 | -71.23983 | |||||||||||||||
Massachusetts General Hospital | Transplant | Boston | MA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceELITE | Hospital: $125,000 | Professional: 80% of Billed Charges | 40 | $2,260 Med/Surg | $2,920 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 80% of Billed Charges | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | |||||||||||||||
Massachusetts General Hospital | Transplant | Boston | MA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceELITE | Hospital: $155,000 | Professional: 80% of Billed Charges | 45 | $2,260 Med/Surg | $2,920 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | |||||||||||||||
Massachusetts General Hospital | Transplant | Boston | MA | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceELITE | Hospital: $100,000 | Professional: 80% of Billed Charges | 30 | $2,260 Med/Surg | $2,920 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | |||||||||||||||
Massachusetts General Hospital | Transplant | Boston | MA | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $150,000 | Professional: 80% of Billed Charges | 20 | $2,260 Med/Surg | $2,920 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 80% of Billed Charges | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | |||||||||||||||
Massachusetts General Hospital | Transplant | Boston | MA | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | Hospital (Cadaveric Donor): $62,500 | Hospital (Living Donor): $67,800 | Professional Services: 80% of Billed Charges | 15 | $2,260 Med/Surg | $2,920 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | N/A | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | |||||||||||||||
Massachusetts General Hospital | Transplant | Boston | MA | Liver | Liver | Adult | Programs of Excellence | PerformanceELITE | Hospital: $155,000 | Professional: 80% of Billed Charges | 22 | $2,260 Med/Surg | $2,920 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | N/A | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | |||||||||||||||
Massachusetts General Hospital | Transplant | Boston | MA | Lung | Lung | Adult | Programs of Excellence | PerformanceQUALITY | Hospital (Single Lung): $140,000 | Hospital (Double Lung): $175,000 | Professional Services: 80% of Billed Charges | 25 | $2,260 Med/Surg | $2,920 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | N/A | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | |||||||||||||||
Tufts Medical Center | Transplant | Boston | MA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | $135,000 | N/A | N/A | 100% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | If Billed Charges Exceed $236,250, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | ||||||||||||||||
Tufts Medical Center | Transplant | Boston | MA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | $165,000 | N/A | N/A | 100% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | If Billed Charges Exceed $288,750, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | ||||||||||||||||
Tufts Medical Center | Transplant | Boston | MA | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $95,000 | N/A | N/A | 100% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | If Billed Charges Exceed $166,250, Payment will be the Transplant Case Rate, Plus 50% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | ||||||||||||||||
Tufts Medical Center | Transplant | Boston | MA | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Adult | Member's Choice | 1st Transplant: $95,000 | 2nd Transplant: $124,688 | N/A | N/A | 100% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | If Billed Charges Exceed $166,250 for the First Transplant or $124,688 for the second Transplant, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | ||||||||||||||||
Tufts Medical Center | Transplant | Boston | MA | Heart | Heart | Adult | Programs of Excellence | PerformanceSELECT | $210,000 | N/A | N/A | 100% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost | If Billed Charges Exceed $367,000, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | |||||||||||||||
Tufts Medical Center | Transplant | Boston | MA | Kidney | Kidney | Adult | Member's Choice | $90,000 | N/A | N/A | 100% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost | If Billed Charges Exceed $157,500, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 42.3144556 | -71.0403236 | ||||||||||||||||
Johns Hopkins Hospital | Transplant | Baltimore | MD | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceELITE | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | Included in Case Rate | Hospital: HSCRC Rates | Professional: 80% of Billed Charges | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 39.2848183 | -76.6905365 | |||||||||||||||
Johns Hopkins Hospital | Transplant | Baltimore | MD | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceELITE | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | Included in Case Rate | Hospital: HSCRC Rates | Professional: 80% of Billed Charges | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 39.2848183 | -76.6905365 | |||||||||||||||
Johns Hopkins Hospital | Transplant | Baltimore | MD | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceELITE | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | Included in Case Rate | Hospital: HSCRC Rates | Professional: 80% of Billed Charges | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 39.2848183 | -76.6905365 | |||||||||||||||
Johns Hopkins Hospital | Transplant | Baltimore | MD | Heart | Heart | Adult | Member's Choice | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | Included in Case Rate | Reimbursed at HSCRC Rate | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 39.2848183 | -76.6905365 | ||||||||||||||||
Johns Hopkins Hospital | Transplant | Baltimore | MD | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | Included in Case Rate | Reimbursed at HSCRC Rate | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 39.2848183 | -76.6905365 | |||||||||||||||
Johns Hopkins Hospital | Transplant | Baltimore | MD | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceSELECT | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | Included in Case Rate | Reimbursed at HSCRC Rate | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 39.2848183 | -76.6905365 | |||||||||||||||
Johns Hopkins Hospital | Transplant | Baltimore | MD | Liver | Liver | Adult | Programs of Excellence | PerformanceSELECT | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | Included in Case Rate | Reimbursed at HSCRC Rate | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 39.2848183 | -76.6905365 | |||||||||||||||
Johns Hopkins Hospital | Transplant | Baltimore | MD | Lung | Lung | Adult | Programs of Excellence | PerformanceSELECT | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | Included in Case Rate | Reimbursed at HSCRC Rate | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 39.2848183 | -76.6905365 | |||||||||||||||
Johns Hopkins Hospital | Transplant | Baltimore | MD | Pancreas | Pancreas | Adult | Member's Choice | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | Included in Case Rate | Reimbursed at HSCRC Rate | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 39.2848183 | -76.6905365 | ||||||||||||||||
Johns Hopkins Hospital | Transplant | Baltimore | MD | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | Included in Case Rate | Hospital - HSCRC rates Professional - 80% of Billed Charges | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 39.2848183 | -76.6905365 | ||||||||||||||||
Johns Hopkins Hospital | Transplant | Baltimore | MD | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | Included in Case Rate | Hospital - HSCRC rates Professional - 80% of Billed Charges | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 39.2848183 | -76.6905365 | ||||||||||||||||
Johns Hopkins Hospital | Transplant | Baltimore | MD | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | Included in Case Rate | Hospital - HSCRC rates Professional - 80% of Billed Charges | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 39.2848183 | -76.6905365 | ||||||||||||||||
Johns Hopkins Hospital | Transplant | Baltimore | MD | Heart | Heart | Pediatric | Member's Choice | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | Included in Case Rate | Reimbursed at HSCRC Rate | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 39.2848183 | -76.6905365 | ||||||||||||||||
Johns Hopkins Hospital | Transplant | Baltimore | MD | Kidney | Kidney | Pediatric | Programs of Excellence | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | Included in Case Rate | Reimbursed at HSCRC Rate | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 39.2848183 | -76.6905365 | ||||||||||||||||
Johns Hopkins Hospital | Transplant | Baltimore | MD | Liver | Liver | Pediatric | Member's Choice | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 100% of HSCRC Rates | Professional: 80% of Billed Charges | Included in Case Rate | Reimbursed at HSCRC Rate | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 39.2848183 | -76.6905365 | ||||||||||||||||
University of Maryland Medical System | Transplant | Baltimore | MD | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | $149,051 | Haploidentical: $162,660 | 35 | $3,943 Med/Surg | $4,542 ICU/CCU | N/A | Hospital: 100% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 90 Days Post-Transplant Discharge | 39.2848183 | -76.6905365 | |||||||||||||||
University of Maryland Medical System | Transplant | Baltimore | MD | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceQUALITY | $198,734 | 35 | $3,943 Med/Surg | $4,542 ICU/CCU | N/A | Hospital: 100% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 90 Days Post-Transplant Discharge | 39.2848183 | -76.6905365 | |||||||||||||||
University of Maryland Medical System | Transplant | Baltimore | MD | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceQUALITY | $110,408 | 25 | $3,943 Med/Surg | $4,542 ICU/CCU | N/A | Hospital: 100% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 90 Days Post-Transplant Discharge | 39.2848183 | -76.6905365 | |||||||||||||||
University of Maryland Medical System | Transplant | Baltimore | MD | Heart | Heart | Adult | Programs of Excellence | PerformanceSELECT | $288,900 | 18 | $3,943 Med/Surg | $4,542 ICU/CCU | N/A | Hospital: 100% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Reimbursed at HSCRC Rate | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 90 Days Post-Transplant Discharge | 39.2848183 | -76.6905365 | |||||||||||||||
University of Maryland Medical System | Transplant | Baltimore | MD | Kidney | Kidney | Adult | Member's Choice | Cadaveric Donor: $135,000 | Living Donor: $135,000 | 8 | $3,943 Med/Surg | $4,542 ICU/CCU | N/A | Hospital: 100% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Reimbursed at HSCRC Rate | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 90 Days Post-Transplant Discharge | 39.2848183 | -76.6905365 | ||||||||||||||||
University of Maryland Medical System | Transplant | Baltimore | MD | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceELITE | $224,128 | 14 | $3,943 Med/Surg | $4,542 ICU/CCU | N/A | Hospital: 100% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Reimbursed at HSCRC Rate | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 90 Days Post-Transplant Discharge | 39.2848183 | -76.6905365 | |||||||||||||||
University of Maryland Medical System | Transplant | Baltimore | MD | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | Cadaveric Donor w/o Renal Failure & MELD ⤠34: $232,654 | Cadaveric Donor with Renal Failure & MELD ⥠35: $311,201 | Living Donor: $222,708 | 18 | $3,943 Med/Surg | $4,542 ICU/CCU | N/A | Hospital: 100% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Reimbursed at HSCRC Rate | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 90 Days Post-Transplant Discharge | 39.2848183 | -76.6905365 | |||||||||||||||
University of Maryland Medical System | Transplant | Baltimore | MD | Lung | Lung | Adult | Programs of Excellence | PerformanceQUALITY | Single: $224,558 | Bilateral: $386,225 | 18 | 20 | $3,943 Med/Surg | $4,542 ICU/CCU | N/A | Hospital: 100% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Reimbursed at HSCRC Rate | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 90 Days Post-Transplant Discharge | 39.2848183 | -76.6905365 | |||||||||||||||
University of Maryland Medical System | Transplant | Baltimore | MD | Pancreas | Pancreas | Adult | Member's Choice | $156,779 | 14 | $3,943 Med/Surg | $4,542 ICU/CCU | N/A | Hospital: 100% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Reimbursed at HSCRC Rate | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 90 Days Post-Transplant Discharge | 39.2848183 | -76.6905365 | ||||||||||||||||
University of Maryland Medical System | Transplant | Baltimore | MD | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Adult | Programs of Excellence | PerformanceQUALITY | 1st Infusion: 100% of Case Rate | 2nd Infusion: 80% of Case Rate | 25 |25 | $3,943 Med/Surg | $4,542 ICU/CCU | N/A | Hospital: 100% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 90 Days Post-Transplant Discharge | 39.2848183 | -76.6905365 | |||||||||||||||
University of Maryland Medical System | Transplant | Baltimore | MD | Blood/Marrow (Tandem Auto to Allo) | Tandem Auto to Allo | Adult | Programs of Excellence | PerformanceQUALITY | 1st Infusion: 100% of Case Rate | 2nd Infusion: 80% of Case Rate | 25 |25 | $3,943 Med/Surg | $4,542 ICU/CCU | N/A | Hospital: 100% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 90 Days Post-Transplant Discharge | 39.2848183 | -76.6905365 | |||||||||||||||
Henry Ford Hospital | Transplant | Detroit | MI | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | $134,900 | 35 | $3,000 Med/Surg | $3,500 ICU/CCU | 85% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | Billed Charges Exceed $269,800 Payment will be the Transplant Case Rate, Plus 45% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 42.3528165 | -83.1692446 | |||||||||||||||
Henry Ford Hospital | Transplant | Detroit | MI | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceQUALITY | $175,000 | 40 | $3,000 Med/Surg | $3,500 ICU/CCU | 85% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | Billed Charges Exceed $350,000 Payment will be the Transplant Case Rate, Plus 45% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 42.3528165 | -83.1692446 | |||||||||||||||
Henry Ford Hospital | Transplant | Detroit | MI | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceQUALITY | $84,900 | 30 | $3,000 Med/Surg | $3,500 ICU/CCU | 85% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | Billed Charges Exceed $169,800 Payment will be the Transplant Case Rate, Plus 45% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 42.3528165 | -83.1692446 | |||||||||||||||
Henry Ford Hospital | Transplant | Detroit | MI | Heart | Heart | Adult | Programs of Excellence | PerformanceSELECT | $145,000 | 18 | $3,000 Med/Surg | $3,500 ICU/CCU | 85% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost, Plus 10% | Billed Charges Exceed $290,000 Payment will be the Transplant Case Rate, Plus 45% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 42.3528165 | -83.1692446 | |||||||||||||||
Henry Ford Hospital | Transplant | Detroit | MI | Intestine | Intestine | Adult | Programs of Excellence | 70% of Billed Charges | N/A | N/A | N/A | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost, Plus 10% | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 42.3528165 | -83.1692446 | ||||||||||||||||
Henry Ford Hospital | Transplant | Detroit | MI | Kidney | Kidney | Adult | Programs of Excellence | PerformanceELITE | $69,900 | 12 | $3,000 Med/Surg | $3,500 ICU/CCU | 85% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost, Plus 10% | Billed Charges Exceed $139,800 Payment will be the Transplant Case Rate, Plus 45% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 42.3528165 | -83.1692446 | |||||||||||||||
Henry Ford Hospital | Transplant | Detroit | MI | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $124,850 | 15 | $3,000 Med/Surg | $3,500 ICU/CCU | 85% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost, Plus 10% | Billed Charges Exceed $249,700 Payment will be the Transplant Case Rate, Plus 45% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 42.3528165 | -83.1692446 | ||||||||||||||||
Henry Ford Hospital | Transplant | Detroit | MI | Liver | Liver | Adult | Programs of Excellence | PerformanceELITE | $159,900 | 17 | $3,000 Med/Surg | $3,500 ICU/CCU | 85% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost, Plus 10% | Billed Charges Exceed $319,8000 Payment will be the Transplant Case Rate, Plus 45% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 42.3528165 | -83.1692446 | |||||||||||||||
Henry Ford Hospital | Transplant | Detroit | MI | Lung | Lung | Adult | Member's Choice | $145,000 | 25 | $3,000 Med/Surg | $3,500 ICU/CCU | 85% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost, Plus 10% | If Billed Charges Exceed $290,000, Payment will be the Transplant Case Rate, Plus 45% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 42.3528165 | -83.1692446 | ||||||||||||||||
Henry Ford Hospital | Transplant | Detroit | MI | Pancreas | Pancreas | Adult | Member's Choice | $89,900 | 15 | $3,000 Med/Surg | $3,500 ICU/CCU | 85% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost, Plus 10% | If Billed Charges Exceed $179,800, Payment will be the Transplant Case Rate, Plus 45% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 42.3528165 | -83.1692446 | ||||||||||||||||
Karmanos Cancer Institute | Transplant | Detroit | MI | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | $130,000 | 45 | $1,800 Non-ICU | $2,400 ICU | 85% of Billed Charges | Hospital: 70% of Billed Charges | Professional: 80% of Billed Charges | Included in Case Rate | 70% of Billed Charges | Billed Charges Exceed the Outlier Threshold of $260,000, Payment will be the Transplant Case Rate, Plus 60% of the Charges Beyond the Outlier Threshold Amount | Begins at Evaluation | Begins on the First Day of Transplant Admission and Ends when the Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 42.3528165 | -83.1692446 | |||||||||||||||
Karmanos Cancer Institute | Transplant | Detroit | MI | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceQUALITY | $155,000 | 45 | $1,800 Non-ICU | $2,400 ICU | 85% of Billed Charges | Hospital: 70% of Billed Charges | Professional: 80% of Billed Charges | Included in Case Rate | 70% of Billed Charges | Billed Charges Exceed the Outlier Threshold of $310,000, Payment will be the Transplant Case Rate, Plus 60% of the Charges Beyond the Outlier Threshold Amount | Begins at Evaluation | Begins on the First Day of Transplant Admission and Ends when the Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 42.3528165 | -83.1692446 | |||||||||||||||
Karmanos Cancer Institute | Transplant | Detroit | MI | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceQUALITY | $85,000 | 30 | $1,800 Non-ICU | $2,400 ICU | 85% of Billed Charges | Hospital: 70% of Billed Charges | Professional: 80% of Billed Charges | Included in Case Rate | 70% of Billed Charges | If Billed Charges Exceed the Outlier Threshold of $170,000, Payment will be the Transplant Case Rate, Plus 60% of the Charges Beyond the Outlier Threshold Amount | Begins at Evaluation | Begins on the First Day of Transplant Admission and Ends when the Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 42.3528165 | -83.1692446 | |||||||||||||||
Spectrum Health | Transplant | Grand Rapids | MI | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | $162,365 | 25 | 65% of Billed Charges | 95% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 30% of Billed Charges | Begins at Evaluation | The Transplant Phase Begins on the Day of Preparative Regimen and Ends the Day of Discharge | Ends 365 Days from Discharge | 42.9564627 | -85.7301286 | ||||||||||||||||
Spectrum Health | Transplant | Grand Rapids | MI | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | $189,426 | 25 | 65% of Billed Charges | 95% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 30% of Billed Charges | Begins at Evaluation | The Transplant Phase Begins on the Day of Preparative Regimen and Ends the Day of Discharge | Ends 365 Days from Discharge | 42.9564627 | -85.7301286 | ||||||||||||||||
Spectrum Health | Transplant | Grand Rapids | MI | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $108,243 | 25 | 65% of Billed Charges | 95% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 30% of Billed Charges | Begins at Evaluation | The Transplant Phase Begins on the Day of Preparative Regimen and Ends the Day of Discharge | Ends 365 Days from Discharge | 42.9564627 | -85.7301286 | ||||||||||||||||
Spectrum Health | Transplant | Grand Rapids | MI | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | $303,081 | 28 | N/A | 95% of Billed Charges | 70% of Billed Charges | Included in Case Rate | 100% of Invoice Cost | 30% of Billed Charges | Begins at Evaluation | Begins One Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 42.9564627 | -85.7301286 | |||||||||||||||
Spectrum Health | Transplant | Grand Rapids | MI | Lung | Lung | Adult | Programs of Excellence | PerformanceELITE | $243,547 | 30 | N/A | 95% of Billed Charges | 70% of Billed Charges | Included in Case Rate | 100% of Invoice Cost | 30% of Billed Charges | Begins at Evaluation | Begins One Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 42.9564627 | -85.7301286 | |||||||||||||||
Spectrum Health | Transplant | Grand Rapids | MI | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $331,224 | 25 | 65% of Billed Charges | 95% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 30% of Billed Charges | Begins at Evaluation | The Transplant Phase Begins on the Day of Preparative Regimen and Ends the Day of Discharge | Ends 365 Days from Discharge | 42.9564627 | -85.7301286 | ||||||||||||||||
Spectrum Health | Transplant | Grand Rapids | MI | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $331,224 | 25 | 65% of Billed Charges | 95% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 30% of Billed Charges | Begins at Evaluation | The Transplant Phase Begins on the Day of Preparative Regimen and Ends the Day of Discharge | Ends 365 Days from Discharge | 42.9564627 | -85.7301286 | ||||||||||||||||
Spectrum Health | Transplant | Grand Rapids | MI | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $141,040 | 25 | 65% of Billed Charges | 95% of Billed Charges | 70% of Billed Charges | Included in Case Rate, Unless Prior to Inlier Period, then Reimbursment Shall be at the Pre-Transplant Rate | Included in Case Rate | 30% of Billed Charges | Begins at Evaluation | The Transplant Phase Begins on the Day of Preparative Regimen and Ends the Day of Discharge | Ends 365 Days from Discharge | 42.9564627 | -85.7301286 | ||||||||||||||||
University of Michigan Medical Center | Transplant | Ann Arbor | MI | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceSELECT | $167,000 | 30 | Days 31 - 40: $3,200 per Day | Days 40 - Discharge: 85% of Billed Charges | N/A | 85% of Billed Charges | Charges Included in the Transplant Case Rate if Provided During the Inlier Days Period | If Harvesting is Provided Prior to Inlier Period, Reimbursement Shall be at the Pre-Transplant Rate | Paid at Invoice Cost | N/A | Begins at Evaluation | Begins 7 Days Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired or Discharge, Whichever is Earlier | Ends 365 Days from Discharge | 42.2733786 | -83.7727088 | |||||||||||||||
University of Michigan Medical Center | Transplant | Ann Arbor | MI | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceSELECT | $193,600 | 34 | Days 35 - 44: $3,200 per Day |Days 45 - Discharge: 85% of Billed Charges | N/A | 85% of Billed Charges | Charges Included in the Transplant Case Rate if Provided During the Inlier Days Period | If Harvesting is Provided Prior to Inlier Period, Reimbursement Shall be at the Pre-Transplant Rate | Paid at Invoice Cost | N/A | Begins at Evaluation | Begins 7 Days Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired or Discharge, Whichever is Earlier | Ends 365 Days from Discharge | 42.2733786 | -83.7727088 | |||||||||||||||
University of Michigan Medical Center | Transplant | Ann Arbor | MI | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceSELECT | $103,700 | 26 | Days 27 - 36: $3,200 per Day |Days 37 - Discharge: 85% of Billed Charges | N/A | 85% of Billed Charges | Charges Included in the Transplant Case Rate if Provided During the Inlier Days Period | If Harvesting is Provided Prior to Inlier Period, Reimbursement Shall be at the Pre-Transplant Rate | Paid at Invoice Cost | N/A | Begins at Evaluation | Begins 7 Days Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired or Discharge, Whichever is Earlier | Ends 365 Days from Discharge | 42.2733786 | -83.7727088 | |||||||||||||||
University of Michigan Medical Center | Transplant | Ann Arbor | MI | Heart | Heart | Adult | Programs of Excellence | PerformanceSELECT | $166,000 | 28 | Days 29 - 38: $3,200 per Day | Days 39 - Discharge: 85% of Billed Charges | N/A | 85% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins 7 Days Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired or Discharge, Whichever is Earlier | Ends 365 Days from Discharge | 42.2733786 | -83.7727088 | |||||||||||||||
University of Michigan Medical Center | Transplant | Ann Arbor | MI | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | $73,900 | 7 | Days 8 - 17: $3,200 per Day | Days 18 - Discharge: 85% of Billed Charges | N/A | 85% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins 7 Days Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired or Discharge, Whichever is Earlier | Ends 365 Days from Discharge | 42.2733786 | -83.7727088 | |||||||||||||||
University of Michigan Medical Center | Transplant | Ann Arbor | MI | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceSELECT | $114,700 | 11 | Days 12 - 21: $3,200 per Day | Days 22 - Discharge: 85% of Billed Charges | N/A | 85% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins 7 Days Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired or Discharge, Whichever is Earlier | Ends 365 Days from Discharge | 42.2733786 | -83.7727088 | |||||||||||||||
University of Michigan Medical Center | Transplant | Ann Arbor | MI | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | $179,100 | 20 | Days 21 - 30: $3,200 per Day | Days 31 - Discharge: 85% of Billed Charges | N/A | 85% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins 7 Days Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired or Discharge, Whichever is Earlier | Ends 365 Days from Discharge | 42.2733786 | -83.7727088 | |||||||||||||||
University of Michigan Medical Center | Transplant | Ann Arbor | MI | Lung | Lung | Adult | Programs of Excellence | PerformanceQUALITY | Single $150,100 | Bilateral $157,600 | 16 20 | Single Lung: Days 17 - 26: $3,200 per Day | Days 27 - Discharge: 85% of Billed Charges | Bilateral Lung: Days 21 - 30: $3,20000 per Day | Days 31 - Discharge: 85% of Billed Charges | N/A | 85% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins 7 Days Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired or Discharge, Whichever is Earlier | Ends 365 Days from Discharge | 42.2733786 | -83.7727088 | |||||||||||||||
University of Michigan Medical Center | Transplant | Ann Arbor | MI | Pancreas | Pancreas | Adult | Member's Choice | $97,500 | 12 | Days 13 - 22: $3,200 per Day | Days 23 - Discharge: 85% of Billed Charges | N/A | 85% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins 7 Days Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired or Discharge, Whichever is Earlier | Ends 365 Days from Discharge | 42.2733786 | -83.7727088 | ||||||||||||||||
University of Michigan Medical Center | Transplant | Ann Arbor | MI | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $175,500 | 34 | Days 35 - 44: $3,200 per Day | Days 45 - Discharge: $85% of Billed Charges | N/A | 85% of Billed Charges | Charges Included in the Transplant Case Rate if Provided During the Inlier Days Period | If Harvesting is Provided Prior to Inlier Period, Reimbursement Shall be at the Pre-Transplant Rate | Paid at Invoice Cost | N/A | Begins at Evaluation | Begins 7 Days Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired or Discharge, Whichever is Earlier | Ends 365 Days from Discharge | 42.2733786 | -83.7727088 | ||||||||||||||||
University of Michigan Medical Center | Transplant | Ann Arbor | MI | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $215,200 | 37 | Days 38 - 47: $3,200 per Day | Days 48 - Discharge: $85% of Billed Charges | N/A | 85% of Billed Charges | Charges Included in the Transplant Case Rate if Provided During the Inlier Days Period | If Harvesting is Provided Prior to Inlier Period, Reimbursement Shall be at the Pre-Transplant Rate | Paid at Invoice Cost | N/A | Begins at Evaluation | Begins 7 Days Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired or Discharge, Whichever is Earlier | Ends 365 Days from Discharge | 42.2733786 | -83.7727088 | ||||||||||||||||
University of Michigan Medical Center | Transplant | Ann Arbor | MI | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $139,900 | 32 | Days 33 - 42: $3,200 per Day | Days 43 - Discharge: $85% of Billed Charges | N/A | 85% of Billed Charges | Charges Included in the Transplant Case Rate if Provided During the Inlier Days Period | If Harvesting is Provided Prior to Inlier Period, Reimbursement Shall be at the Pre-Transplant Rate | Paid at Invoice Cost | N/A | Begins at Evaluation | Begins 7 Days Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired or Discharge, Whichever is Earlier | Ends 365 Days from Discharge | 42.2733786 | -83.7727088 | ||||||||||||||||
University of Michigan Medical Center | Transplant | Ann Arbor | MI | Heart | Heart | Pediatric | Programs of Excellence | $194,000 | 40 | Days 41 - 50: $3,200 per Day | Days 51 - Discharge: $85% of Billed Charges | N/A | 85% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins 7 Days Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired or Discharge, Whichever is Earlier | Ends 365 Days from Discharge | 42.2733786 | -83.7727088 | ||||||||||||||||
University of Michigan Medical Center | Transplant | Ann Arbor | MI | Kidney | Kidney | Pediatric | Programs of Excellence | $83,200 | 11 | Days 12 - 21: $3,200 per Day | Days 22 - Discharge: $85% of Billed Charges | N/A | 85% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins 7 Days Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired or Discharge, Whichever is Earlier | Ends 365 Days from Discharge | 42.2733786 | -83.7727088 | ||||||||||||||||
University of Michigan Medical Center | Transplant | Ann Arbor | MI | Liver | Liver | Pediatric | Programs of Excellence | $176,600 | 17 | Days 18 - 27: $3,200 per Day | Days 28 - Discharge: $85% of Billed Charges | N/A | 85% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins 7 Days Prior to Transplantation and Ends when Inlier and any Applicable Outlier Days have Expired or Discharge, Whichever is Earlier | Ends 365 Days from Discharge | 42.2733786 | -83.7727088 | ||||||||||||||||
Rochester Methodist Hospital (Mayo Clinic) | Transplant | Rochester | MN | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceSELECT | Matched Donor: $118,000 | Mismatched Donor: $138,000 | 100 | N/A | 95% of Billed Charges | 95% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins 10 Days Prior to the initial Infusion Date and Ends when the Inlier Days have Expired | Ends 365 Days from Discharge | 43.996149 | -92.6212551 | |||||||||||||||
Rochester Methodist Hospital (Mayo Clinic) | Transplant | Rochester | MN | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceSELECT | $138,000 | 100 | N/A | 95% of Billed Charges | 95% of Billed Charges | Included in Case Rate | Included in Case Rate | 70% of Billed Charges | Begins at Evaluation | Begins 10 Days Prior to the initial Infusion Date and Ends when the Inlier Days have Expired | Ends 365 Days from Discharge | 43.996149 | -92.6212551 | |||||||||||||||
Rochester Methodist Hospital (Mayo Clinic) | Transplant | Rochester | MN | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceSELECT | $69,000 | 50 | N/A | 95% of Billed Charges | 95% of Billed Charges | Included in Case Rate | Included in Case Rate | 70% of Billed Charges | Begins at Evaluation | Begins 10 Days Prior to the initial Infusion Date and Ends when the Inlier Days have Expired | Ends 365 Days from Discharge | 43.996149 | -92.6212551 | |||||||||||||||
Rochester Methodist Hospital (Mayo Clinic) | Transplant | Rochester | MN | Heart | Heart | Adult | Member's Choice | $98,000 | N/A | N/A | 95% of Billed Charges | 95% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant, Unless Patient is Admitted One (1) Day Prior to Transplant, then the Transplant Phase Begins at Admission | Ends 365 Days from Discharge | 43.996149 | -92.6212551 | ||||||||||||||||
Rochester Methodist Hospital (Mayo Clinic) | Transplant | Rochester | MN | Heart/Lung | Heart/Lung | Adult | Member's Choice | $114,000 | N/A | N/A | 95% of Billed Charges | 95% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant, Unless Patient is Admitted One (1) Day Prior to Transplant, then the Transplant Phase Begins at Admission | Ends 365 Days from Discharge | 43.996149 | -92.6212551 | ||||||||||||||||
Rochester Methodist Hospital (Mayo Clinic) | Transplant | Rochester | MN | Kidney | Kidney | Adult | Programs of Excellence | PerformanceELITE | Cadaveric Donor: $48,000 | Living Donor: $62,000 | N/A | N/A | 95% of Billed Charges | 95% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant, Unless Patient is Admitted One (1) Day Prior to Transplant, then the Transplant Phase Begins at Admission | Ends 365 Days from Discharge | 43.996149 | -92.6212551 | |||||||||||||||
Rochester Methodist Hospital (Mayo Clinic) | Transplant | Rochester | MN | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceQUALITY | $98,000 | N/A | N/A | 95% of Billed Charges | 95% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant, Unless Patient is Admitted One (1) Day Prior to Transplant, then the Transplant Phase Begins at Admission | Ends 365 Days from Discharge | 43.996149 | -92.6212551 | |||||||||||||||
Rochester Methodist Hospital (Mayo Clinic) | Transplant | Rochester | MN | Liver | Liver | Adult | Programs of Excellence | PerformanceSELECT | Cadaveric Donor: $128,000 | Living Donor: $158,000 | N/A | N/A | 95% of Billed Charges | 95% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant, Unless Patient is Admitted One (1) Day Prior to Transplant, then the Transplant Phase Begins at Admission | Ends 365 Days from Discharge | 43.996149 | -92.6212551 | |||||||||||||||
Rochester Methodist Hospital (Mayo Clinic) | Transplant | Rochester | MN | Lung | Lung | Adult | Member's Choice | $104,000 | N/A | N/A | 95% of Billed Charges | 95% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins on the Day of Transplant, Unless Patient is Admitted One (1) Day Prior to Transplant, then the Transplant Phase Begins at Admission | Ends 365 Days from Discharge | 43.996149 | -92.6212551 | ||||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | $140,000 | 50 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | |||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceQUALITY | $165,000 | 50 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | |||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Blood/Marrow (Cord Blood) | Cord Blood | Adult | Member's Choice | $185,000 | 50 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | ||||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceQUALITY | $90,000 | 20 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | |||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | Without Prior VAD Placement: $125,000 | With Prior VAD Placement: $150, 000 | 25 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 65% of Billed Charges | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | |||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Heart/Kidney | Heart/Kidney | Adult | Member's Choice | $190,000 | 25 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 65% of Billed Charges | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | ||||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Heart/Lung | Heart/Lung | Adult | Member's Choice | $150,000 | 35 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 65% of Billed Charges | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | ||||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Intestine | Intestine | Adult | Member's Choice | Cadaveric Donor: $200,000 | Living Donor: $175,000 | 35 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 65% of Billed Charges | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | ||||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Intestine/Liver | Intestine/Liver | Adult | Member's Choice | $275,000 | 40 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 65% of Billed Charges | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | ||||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Islet (Allogeneic) | Islet | Adult | Member's Choice | $95,000 | 15 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | N/A | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | ||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Islet (Autologous) | Islet | Adult | Member's Choice | $125,000 | 15 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | N/A | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | ||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | Cadaveric Donor: $85,000 | Living Donor: $75,000 | 12 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 65% of Billed Charges | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | |||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Kidney/Liver | Kidney/Liver | Adult | Member's Choice | $190,000 | 25 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 65% of Billed Charges | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | ||||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Kidney/Lung | Adult | Member's Choice | $190,000 | 25 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 65% of Billed Charges | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | |||||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceSELECT | $110,000 | 20 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 65% of Billed Charges | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | |||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Liver | Liver | Adult | Programs of Excellence | PerformanceSELECT | Cadaveric Donor Meld Score < 20: $145,000 | Cadaveric Donor Meld Score > 20: $180,000 | Living Donor: $140,000 | 20 | 25 | 25 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 65% of Billed Charges | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | |||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Lung | Lung | Adult | Member's Choice | Cadaveric Donor: $140,000 | Living Donor: $200,000 | 25 | 20 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 65% of Billed Charges | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | ||||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $175,000 | 50 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | ||||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $225,000 | 50 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | ||||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $95,000 | 20 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | ||||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Islet (Allogeneic) | Islet | Pediatric | Member's Choice | $95,000 | 15 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | ||||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Islet (Autologous) | Islet | Pediatric | Member's Choice | $125,000 | 15 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | ||||||||||||||||
University of Minnesota Medical Center, Fairview | Transplant | Minneapolis | MN | Kidney | Kidney | Pediatric | Programs of Excellence | Cadaveric Donor: $120,000 | Living Donor: $110,000 | 15 | $3,200 Med/Surg | $3,200 ICU/CCU | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 65% of Billed Charges | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 44.970797 | -93.3315181 | ||||||||||||||||
Barnes-Jewish Hospital | Transplant | St Louis | MO | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | Hospital: $182,913 | Professional: $31,978 | N/A | N/A | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at the Earlier of Discharge or Transfer to Inpatient rehabilitation | Ends One (1) Year from Discharge | 38.653285 | -90.3835452 | ||||||||||||||||
Barnes-Jewish Hospital | Transplant | St Louis | MO | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | Hospital: $241,544 | Professional: $42,220 | N/A | N/A | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at the Earlier of Discharge or Transfer to Inpatient rehabilitation | Ends One (1) Year from Discharge | 38.653285 | -90.3835452 | ||||||||||||||||
Barnes-Jewish Hospital | Transplant | St Louis | MO | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | Hospital: $124,895 | Professional: $21,835 | N/A | N/A | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at the Earlier of Discharge or Transfer to Inpatient rehabilitation | Ends One (1) Year from Discharge | 38.653285 | -90.3835452 | ||||||||||||||||
Barnes-Jewish Hospital | Transplant | St Louis | MO | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $239,820 | Professional: $54,563 | N/A | N/A | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at 70% of Billed Charges | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at the Earlier of Discharge or Transfer to Inpatient rehabilitation | Ends One (1) Year from Discharge | 38.653285 | -90.3835452 | |||||||||||||||
Barnes-Jewish Hospital | Transplant | St Louis | MO | Heart/Lung | Heart/Lung | Adult | Member's Choice | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | 38.653285 | -90.3835452 | ||||||||||||||||
Barnes-Jewish Hospital | Transplant | St Louis | MO | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | Cadaveric Donor Hospital: $99,568 | Cadaveric Donor Professional: $18,695 | Living Donor Hospital: $107,761 | Living Donor Professional: $28,345 | N/A | N/A | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at 70% of Billed Charges | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at the Earlier of Discharge or Transfer to Inpatient Rehabilitation Unit or Facility | Ends 365 Days from Discharge | 38.653285 | -90.3835452 | |||||||||||||||
Barnes-Jewish Hospital | Transplant | St Louis | MO | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceQUALITY | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | 38.653285 | -90.3835452 | |||||||||||||||
Barnes-Jewish Hospital | Transplant | St Louis | MO | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | Cadaveric Donor Hospital: $196,705 | Cadaveric Donor Professional: $47,684 | Living Donor Hospital: $223,985 | Living Donor Professional: $48,051 | N/A | N/A | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at 70% of Billed Charges | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at the Earlier of Discharge or Transfer to Inpatient Rehabilitation Unit or Facility | Ends 365 Days from Discharge | 38.653285 | -90.3835452 | |||||||||||||||
Barnes-Jewish Hospital | Transplant | St Louis | MO | Lung | Lung | Adult | Programs of Excellence | PerformanceELITE | Single Lung Hospital: $201,450 | Single Lung Professional: $47,893 | Bilateral Lung Hospital: $247,421 | Bilateral Lung Professional: $53,724 | N/A | N/A | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at 70% of Billed Charges | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at the Earlier of Discharge or Transfer to Inpatient Rehabilitation Unit or Facility | Ends 365 Days from Discharge | 38.653285 | -90.3835452 | |||||||||||||||
Barnes-Jewish Hospital | Transplant | St Louis | MO | Pancreas | Pancreas | Adult | Member's Choice | Hospital: 70% of Billed Charges | Professional: 70% of Billed Charges | N/A | N/A | N/A | 70% of Billed Charges | Included in Case Rate | Reimbursed at 70% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at the Earlier of Discharge or Transfer to Inpatient Rehabilitation Unit or Facility | Ends 365 Days from Discharge | 38.653285 | -90.3835452 | ||||||||||||||||
SSM Health Saint Louis University Hospital | Transplant | St Louis | MO | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | $135,000 | 30 | $2,700 Med/Surg | $3,200 ICU/CCU | 75% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 38.653285 | -90.3835452 | ||||||||||||||||
SSM Health Saint Louis University Hospital | Transplant | St Louis | MO | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | $175,000 | 40 | $2,700 Med/Surg | $3,200 ICU/CCU | 75% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 38.653285 | -90.3835452 | ||||||||||||||||
SSM Health Saint Louis University Hospital | Transplant | St Louis | MO | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $85,000 | 22 | $2,700 Med/Surg | $3,200 ICU/CCU | 75% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 38.653285 | -90.3835452 | ||||||||||||||||
SSM Health Saint Louis University Hospital | Transplant | St Louis | MO | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | $64,000 | 8 | $2,700 Med/Surg | $3,200 ICU/CCU | 75% of Billed Charges | 70% of Billed Charges | Included in Case Rate if Organ was Procured within the UNOS Region of this Hospital, Otherwise, Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 38.653285 | -90.3835452 | ||||||||||||||||
SSM Health Saint Louis University Hospital | Transplant | St Louis | MO | Kidney/Liver | Kidney/Liver | Adult | Member's Choice | $170,000 | 20 | $2,700 Med/Surg | $3,200 ICU/CCU | 75% of Billed Charges | 70% of Billed Charges | Included in Case Rate if Organ was Procured within the UNOS Region of this Hospital, Otherwise, Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 38.653285 | -90.3835452 | |||||||||||||||||
SSM Health Saint Louis University Hospital | Transplant | St Louis | MO | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $120,000 | 20 | $2,700 Med/Surg | $3,200 ICU/CCU | 75% of Billed Charges | 70% of Billed Charges | Included in Case Rate if Organ was Procured within the UNOS Region of this Hospital, Otherwise, Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 38.653285 | -90.3835452 | |||||||||||||||||
SSM Health Saint Louis University Hospital | Transplant | St Louis | MO | Liver | Liver | Adult | Member's Choice | $130,000 | 13 | $2,700 Med/Surg | $3,200 ICU/CCU | 75% of Billed Charges | 70% of Billed Charges | Included in Case Rate if Organ was Procured within the UNOS Region of this Hospital, Otherwise, Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 38.653285 | -90.3835452 | |||||||||||||||||
SSM Health Saint Louis University Hospital | Transplant | St Louis | MO | Pancreas | Pancreas | Adult | Member's Choice | $92,000 | 18 | $2,700 Med/Surg | $3,200 ICU/CCU | 75% of Billed Charges | 70% of Billed Charges | Included in Case Rate if Organ was Procured within the UNOS Region of this Hospital, Otherwise, Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 38.653285 | -90.3835452 | |||||||||||||||||
St Louis Children's Hospital | Transplant | St Louis | MO | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $105,000 | N/A | N/A | N/A | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | If Billed Charges Exceed $139,650, Payment will be the Transplant Case Rate, Plus 75% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 365 Days from Discharge | 38.653285 | -90.3835452 | ||||||||||||||||
St Louis Children's Hospital | Transplant | St Louis | MO | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $125,000 | N/A | N/A | N/A | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | If Billed Charges Exceed $166,500, Payment will be the Transplant Case Rate, Plus 75% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 365 Days from Discharge | 38.653285 | -90.3835452 | ||||||||||||||||
St Louis Children's Hospital | Transplant | St Louis | MO | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $85,000 | N/A | N/A | N/A | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | If Billed Charges Exceed $113,000, Payment will be the Transplant Case Rate, Plus 75% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 365 Days from Discharge | 38.653285 | -90.3835452 | ||||||||||||||||
St Louis Children's Hospital | Transplant | St Louis | MO | Heart | Heart | Pediatric | Programs of Excellence | $60,000 | N/A | N/A | N/A | 80% of Billed Charges | Included in Case Rate | 80% of Billed Charges | If Billed Charges Exceed $80,000, Payment will be the Transplant Case Rate, Plus 75% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 38.653285 | -90.3835452 | ||||||||||||||||
St Louis Children's Hospital | Transplant | St Louis | MO | Heart/Lung | Heart/Lung | Pediatric | Member's Choice | $180,000 | N/A | N/A | N/A | 80% of Billed Charges | Included in Case Rate | 80% of Billed Charges | If Billed Charges Exceed $232,000, Payment will be the Transplant Case Rate, Plus 75% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 38.653285 | -90.3835452 | ||||||||||||||||
St Louis Children's Hospital | Transplant | St Louis | MO | Kidney | Kidney | Pediatric | Member's Choice | $62,000 | N/A | N/A | N/A | 80% of Billed Charges | Included in Case Rate | 80% of Billed Charges | If Billed Charges Exceed $82,000, Payment will be the Transplant Case Rate, Plus 75% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 38.653285 | -90.3835452 | ||||||||||||||||
St Louis Children's Hospital | Transplant | St Louis | MO | Liver | Liver | Pediatric | Programs of Excellence | $120,000 | N/A | N/A | N/A | 80% of Billed Charges | Included in Case Rate | 80% of Billed Charges | If Billed Charges Exceed $160,000, Payment will be the Transplant Case Rate, Plus 75% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 38.653285 | -90.3835452 | ||||||||||||||||
St Louis Children's Hospital | Transplant | St Louis | MO | Lung | Lung | Pediatric | Programs of Excellence | $105,000 | N/A | N/A | N/A | 80% of Billed Charges | Included in Case Rate | 80% of Billed Charges | If Billed Charges Exceed $139,650, Payment will be the Transplant Case Rate, Plus 75% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 38.653285 | -90.3835452 | ||||||||||||||||
University of Mississippi Medical Center | Transplant | Jackson | MS | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | $141,000 | 30 | $2,850 Med/Surg | $3,850 ICU/CCU | 100% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | If Billed Charges Exceed $246,750, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 32.3104541 | -90.2638272 | ||||||||||||||||
University of Mississippi Medical Center | Transplant | Jackson | MS | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | $160,000 | 35 | $2,850 Med/Surg | $3,850 ICU/CCU | 100% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | If Billed Charges Exceed $280,000, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 32.3104541 | -90.2638272 | ||||||||||||||||
University of Mississippi Medical Center | Transplant | Jackson | MS | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $96,000 | 25 | $2,850 Med/Surg | $3,850 ICU/CCU | 100% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | If Billed Charges Exceed $168,000, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends 365 Days from Discharge | 32.3104541 | -90.2638272 | ||||||||||||||||
University of Mississippi Medical Center | Transplant | Jackson | MS | Heart | Heart | Adult | Member's Choice | $172,000 | 28 | $2,850 Med/Surg | $3,850 ICU/CCU | 100% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost + 15% | IF Billed Charges Exceed $301,000, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 32.3104541 | -90.2638272 | ||||||||||||||||
University of Mississippi Medical Center | Transplant | Jackson | MS | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | $75,000 | 8 | $2,850 Med/Surg | $3,850 ICU/CCU | 100% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost + 15% | If Billed Charges Exceed $131,250, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 32.3104541 | -90.2638272 | |||||||||||||||
University of Mississippi Medical Center | Transplant | Jackson | MS | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $130,000 | 18 | $2,850 Med/Surg | $3,850 ICU/CCU | 100% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost + 15% | If Billed Charges Exceed $227,500, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 32.3104541 | -90.2638272 | ||||||||||||||||
University of Mississippi Medical Center | Transplant | Jackson | MS | Liver | Liver | Adult | Member's Choice | $148,000 | 14 | $2,850 Med/Surg | $3,850 ICU/CCU | 100% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost + 15% | If Billed Charges Exceed $259,000, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 32.3104541 | -90.2638272 | ||||||||||||||||
University of Mississippi Medical Center | Transplant | Jackson | MS | Pancreas | Pancreas | Adult | Member's Choice | $93,000 | 12 | $2,850 Med/Surg | $3,850 ICU/CCU | 100% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost + 15% | If Billed Charges Exceed $162,750, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 32.3104541 | -90.2638272 | ||||||||||||||||
Duke University Hospital | Transplant | Durham | NC | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | $200,000 | N/A | N/A | 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | Included in Case Rate | If Billed Charges Exceed $340,000, Payment will be the Case Rate, Plus 73% of the Excess Charges | Begins at Evaluation | Begins on the Day of Preparatory Regimen and Ends when the Patient is Discharged | Ends 365 Days from Discharge | 36.0020232 | -79.0249944 | |||||||||||||||
Duke University Hospital | Transplant | Durham | NC | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceQUALITY | $248,000 | N/A | N/A | 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | Included in Case Rate | If Billed Charges Exceed $421,600, Payment will be the Case Rate, Plus 73% of the Excess Charges | Begins at Evaluation | Begins on the Day of Preparatory Regimen and Ends when the Patient is Discharged | Ends 365 Days from Discharge | 36.0020232 | -79.0249944 | |||||||||||||||
Duke University Hospital | Transplant | Durham | NC | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceQUALITY | $100,000 | N/A | N/A | 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | N/A | If Billed Charges Exceed $170,000, Payment will be the Case Rate, Plus 73% of the Excess Charges | Begins at Evaluation | Begins on the Day of Preparatory Regimen and Ends when the Patient is Discharged | Ends 365 Days from Discharge | 36.0020232 | -79.0249944 | |||||||||||||||
Duke University Hospital | Transplant | Durham | NC | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | $220,000 | N/A | N/A | 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | 70% of Billed Charges | If Billed Charges Exceed $374,000, Payment will be the Case Rate, Plus 73% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 36.0020232 | -79.0249944 | |||||||||||||||
Duke University Hospital | Transplant | Durham | NC | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | Cadaveric Donor: $98,000 | Living Donor: $105,000 | N/A | N/A | 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | 70% of Billed Charges | If Billed Charges Exceed $178,500 (Cadaveric) or $166,600 (Living), Payment will be the Case Rate, Plus 73% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 36.0020232 | -79.0249944 | |||||||||||||||
Duke University Hospital | Transplant | Durham | NC | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceQUALITY | $155,000 | N/A | N/A | 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | 70% of Billed Charges | If Billed Charges Exceed $263,500, Payment will be the Case Rate, Plus 73% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 36.0020232 | -79.0249944 | |||||||||||||||
Duke University Hospital | Transplant | Durham | NC | Liver | Liver | Adult | Programs of Excellence | PerformanceSELECT | Cadaveric Donor: $180,000 | Living Donor: $190,000 | N/A | N/A | 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | 70% of Billed Charges | If Billed Charges Exceed $323,000 (Cadaveric or Living), Payment will be the Case Rate, Plus 73% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 36.0020232 | -79.0249944 | |||||||||||||||
Duke University Hospital | Transplant | Durham | NC | Lung | Lung | Pediatric | Programs of Excellence | Single: $260,000 | Bilateral: $270,000 | N/A | N/A | 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | 70% of Billed Charges | If Billed Charges Exceed $450,500 (Single) or $459,000 (Bilateral), Payment will be the Case Rate, Plus 73% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 36.0020232 | -79.0249944 | ||||||||||||||||
Duke University Hospital | Transplant | Durham | NC | Lung | Lung | Adult | Programs of Excellence | PerformanceELITE | Single: $250,000 | Bilateral: $265,000 | N/A | N/A | 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | 70% of Billed Charges | If Billed Charges Exceed $425,000 (Single) or $442,000 (Bilateral), Payment will be the Case Rate, Plus 73% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 36.0020232 | -79.0249944 | |||||||||||||||
Duke University Hospital | Transplant | Durham | NC | Heart | Heart | Pediatric | Programs of Excellence | $240,000 | N/A | N/A | 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | 70% of Billed Charges | If Billed Charges Exceed $408,000, Payment will be the Case Rate, Plus 73% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 36.0020232 | -79.0249944 | ||||||||||||||||
Duke University Hospital | Transplant | Durham | NC | Kidney | Kidney | Pediatric | Member's Choice | Cadaveric Donor: $98,000 | Living Donor: $105,000 | N/A | N/A | 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | 70% of Billed Charges | If Billed Charges Exceed $178,500 (Cadaveric) or $166,600 (Living), Payment will be the Case Rate, Plus 73% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 36.0020232 | -79.0249944 | ||||||||||||||||
Duke University Hospital | Transplant | Durham | NC | Liver | Liver | Pediatric | Programs of Excellence | Cadaveric Donor: $180,000 | Living Donor: $190,000 | N/A | N/A | 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | 70% of Billed Charges | If Billed Charges Exceed $306,000, Payment will be the Transplant Case Rate, Plus 73% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 36.0020232 | -79.0249944 | ||||||||||||||||
University of North Carolina Hospitals | Transplant | Chapel Hill | NC | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceSELECT | $164,617 | N/A | N/A | 100% of Billed Charges | 65% of Billed Charges | Included in the Case Rate | 65% of Billed Charges | If Billed Charges Exceed $329,234, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 35.9210234 | -79.0743104 | |||||||||||||||
University of North Carolina Hospitals | Transplant | Chapel Hill | NC | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceSELECT | $202,873 | N/A | N/A | 100% of Billed Charges | 65% of Billed Charges | Included in the Case Rate | 65% of Billed Charges | If Billed Charges Exceed $405,746, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 35.9210234 | -79.0743104 | |||||||||||||||
University of North Carolina Hospitals | Transplant | Chapel Hill | NC | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceSELECT | $110,131 | N/A | N/A | 100% of Billed Charges | 65% of Billed Charges | Included in the Case Rate | 65% of Billed Charges | If Billed Charges Exceed $220,262, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 35.9210234 | -79.0743104 | |||||||||||||||
University of North Carolina Hospitals | Transplant | Chapel Hill | NC | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | $173,891 | N/A | N/A | 100% of Billed Charges | 65% of Billed Charges | Included in Case Rate | 75% of Billed Charges | If Billed Charges Exceed $347,782, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 35.9210234 | -79.0743104 | |||||||||||||||
University of North Carolina Hospitals | Transplant | Chapel Hill | NC | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | $93,901 | N/A | N/A | 100% of Billed Charges | 65% of Billed Charges | Included in Case Rate | 75% of Billed Charges | If Billed Charges Exceed $187,802, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 35.9210234 | -79.0743104 | |||||||||||||||
University of North Carolina Hospitals | Transplant | Chapel Hill | NC | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | $162,298 | N/A | N/A | 100% of Billed Charges | 65% of Billed Charges | Included in Case Rate | 75% of Billed Charges | If Billed Charges Exceed $324,596, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 35.9210234 | -79.0743104 | |||||||||||||||
University of North Carolina Hospitals | Transplant | Chapel Hill | NC | Lung | Lung | Adult | Programs of Excellence | PerformanceQUALITY | $162,298 | N/A | N/A | 100% of Billed Charges | 65% of Billed Charges | Included in Case Rate | 75% of Billed Charges | If Billed Charges Exceed $324,596, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 35.9210234 | -79.0743104 | |||||||||||||||
University of North Carolina Hospitals | Transplant | Chapel Hill | NC | Pancreas | Pancreas | Adult | Member's Choice | 65% of Billed Charges | N/A | 100% of Billed Charges | 65% of Billed Charges | Included in Case Rate | 75% of Billed Charges | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 35.9210234 | -79.0743104 | |||||||||||||||||
University of North Carolina Hospitals | Transplant | Chapel Hill | NC | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $164,617 | N/A | N/A | 100% of Billed Charges | 65% of Billed Charges | Included in Case Rate | 65% of Billed Charges | If Billed Charges Exceed $329,234, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 35.9210234 | -79.0743104 | ||||||||||||||||
University of North Carolina Hospitals | Transplant | Chapel Hill | NC | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $202,873 | N/A | N/A | 100% of Billed Charges | 65% of Billed Charges | Included in Case Rate | 65% of Billed Charges | If Billed Charges Exceed $405,746, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 35.9210234 | -79.0743104 | ||||||||||||||||
University of North Carolina Hospitals | Transplant | Chapel Hill | NC | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $110,131 | N/A | N/A | 100% of Billed Charges | 65% of Billed Charges | Included in Case Rate | N/A | If Billed Charges Exceed $220,262, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 35.9210234 | -79.0743104 | ||||||||||||||||
University of North Carolina Hospitals | Transplant | Chapel Hill | NC | Heart | Heart | Pediatric | Member's Choice | $173,891 | N/A | N/A | 100% of Billed Charges | 65% of Billed Charges | Included in Case Rate | 75% of Billed Charges | If Billed Charges Exceed $347,782, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 35.9210234 | -79.0743104 | ||||||||||||||||
University of North Carolina Hospitals | Transplant | Chapel Hill | NC | Kidney | Kidney | Pediatric | Programs of Excellence | $93,901 | N/A | N/A | 100% of Billed Charges | 65% of Billed Charges | Included in Case Rate | 75% of Billed Charges | If Billed Charges Exceed $187,802, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 35.9210234 | -79.0743104 | ||||||||||||||||
University of North Carolina Hospitals | Transplant | Chapel Hill | NC | Liver | Liver | Pediatric | Member's Choice | 65% of Billed Charges | N/A | 65% of Billed Charges | N/A | 65% of Billed Charges | Included in Case Rate | 75% of Billed Charges | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 35.9210234 | -79.0743104 | ||||||||||||||||
University of North Carolina Hospitals | Transplant | Chapel Hill | NC | Lung | Lung | Pediatric | Member's Choice | $162,298 | N/A | N/A | 100% of Billed Charges | 65% of Billed Charges | Included in Case Rate | 75% of Billed Charges | If Billed Charges Exceed $324,596, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 35.9210234 | -79.0743104 | ||||||||||||||||
University of North Carolina Hospitals | Transplant | Chapel Hill | NC | Pancreas | Pancreas | Pediatric | Member's Choice | 65% of Billed Charges | N/A | N/A | N/A | 65% of Billed Charges | Included in Case Rate | 75% of Billed Charges | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 35.9210234 | -79.0743104 | ||||||||||||||||
The Nebraska Medical Center | Transplant | Omaha | NE | Blood/Marrow (Cord Blood) | Cord Blood | Adult | Member's Choice | 75% of Billed Charges | N/A | N/A | N/A | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Day 101 Post Inlier Days Period | 41.2918376 | -96.1514595 | ||||||||||||||||
The Nebraska Medical Center | Transplant | Omaha | NE | Blood/Marrow (Tandem Auto-to-Allo) | Tandem Auto to Allo | Adult | Member's Choice | 1st: $110,000; 2nd (Related): $116,000 | 1st: $110,000; 2nd (Unrelated): $148,000 | 20, 30 | 20, 32 | $2,000 Med/Surg | $2,775 ICU/CCU | 90% of Billed Charges | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 58% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Day 101 Post Inlier Days Period | 41.2918376 | -96.1514595 | ||||||||||||||||
The Nebraska Medical Center | Transplant | Omaha | NE | Blood/Marrow (Tandem Auto-to-Auto) | Tandem Auto to Auto | Adult | Member's Choice | 1st: $110,000 | 2nd: $88,000 | 20 | 20 | $2,000 Med/Surg | $2,775 ICU/CCU | 90% of Billed Charges | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 58% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Day 101 Post Inlier Days Period | 41.2918376 | -96.1514595 | ||||||||||||||||
The Nebraska Medical Center | Transplant | Omaha | NE | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | $145,000 | 30 | $2,000 Med/Surg | $2,775 ICU/CCU | 90% of Billed Charges | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 58% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Day 101 Post Inlier Days Period | 41.2918376 | -96.1514595 | ||||||||||||||||
The Nebraska Medical Center | Transplant | Omaha | NE | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | $185,000 | 32 | $2,000 Med/Surg | $2,775 ICU/CCU | 90% of Billed Charges | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 58% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | One (1) Year from Day 31 Post Inlier Days Period | 41.2918376 | -96.1514595 | ||||||||||||||||
The Nebraska Medical Center | Transplant | Omaha | NE | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $110,000 | 20 | $1,600 Med/Surg | $2,675 ICU/CCU | 90% of Billed Charges | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 58% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | One (1) Year from Day 31 Post Inlier Days Period | 41.2918376 | -96.1514595 | ||||||||||||||||
The Nebraska Medical Center | Transplant | Omaha | NE | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | $180,000 | 18 | $2,000 Med/Surg | $2,600 ICU/CCU | 90% of Billed Charges | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 58% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Day 91 Post Discharge | 41.2918376 | -96.1514595 | |||||||||||||||
The Nebraska Medical Center | Transplant | Omaha | NE | Kidney | Kidney | Adult | Programs of Excellence | PerformanceELITE | $67,500 | 12 Patient | 7 Donor | $2,000 Med/Surg | $2,600 ICU/CCU | 90% of Billed Charges | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 58% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Day 91 Post Discharge | 41.2918376 | -96.1514595 | |||||||||||||||
The Nebraska Medical Center | Transplant | Omaha | NE | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceSELECT | $127,000 | 19 | $2,000 Med/Surg | $2,600 ICU/CCU | 90% of Billed Charges | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 58% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Day 91 Post Discharge | 41.2918376 | -96.1514595 | |||||||||||||||
The Nebraska Medical Center | Transplant | Omaha | NE | Liver | Liver | Adult | Programs of Excellence | PerformanceSELECT | $160,000 | 20 Patient | 7 Donor | $2,000 Med/Surg | $2,600 ICU/CCU | 90% of Billed Charges | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 58% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Day 91 Post Discharge | 41.2918376 | -96.1514595 | |||||||||||||||
The Nebraska Medical Center | Transplant | Omaha | NE | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $145,000 | 30 | $2,000 Med/Surg | $2,775 ICU/CCU | 90% of Billed Charges | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 58% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Day 101 Post Discharge | 41.2918376 | -96.1514595 | ||||||||||||||||
The Nebraska Medical Center | Transplant | Omaha | NE | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $185,000 | 32 | $2,000 Med/Surg | $2,775 ICU/CCU | 90% of Billed Charges | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 58% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Day 101 Post Discharge | 41.2918376 | -96.1514595 | ||||||||||||||||
The Nebraska Medical Center | Transplant | Omaha | NE | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $110,000 | 20 | $1,600 Med/Surg | $2,675 ICU/CCU | 90% of Billed Charges | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | N/A | 58% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Day 31 Post Discharge | 41.2918376 | -96.1514595 | ||||||||||||||||
The Nebraska Medical Center | Transplant | Omaha | NE | Intestine | Intestine | Pediatric | Programs of Excellence | 75% of Billed Charges | N/A | N/A | N/A | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Day 91 Post Discharge | 41.2918376 | -96.1514595 | ||||||||||||||||
The Nebraska Medical Center | Transplant | Omaha | NE | Kidney | Kidney | Pediatric | Member's Choice | $72,000 | 12 Patient | 7 Donor | $2,000 Med/Surg | $2,600 ICU/CCU | 90% of Billed Charges | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 58% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Day 91 Post Discharge | 41.2918376 | -96.1514595 | ||||||||||||||||
The Nebraska Medical Center | Transplant | Omaha | NE | Liver | Liver | Pediatric | Programs of Excellence | $175,000 | 25 Patient | 7 Donor | $2,000 Med/Surg | $2,600 ICU/CCU | 90% of Billed Charges | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 58% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Day 91 Post Discharge | 41.2918376 | -96.1514595 | ||||||||||||||||
University of New Mexico Hospital | Transplant | Albuquerque | NM | Kidney | Kidney | Adult | Member's Choice | $120,000 | 12 | $2,750 Med/Surg | $4,000 ICU/CCU | 90% of Billed Charges | Inpatient: Lesser of 90% of Billed Charges or $2,750 Med/Surg; $4,000 ICU/CCU | Outpatient: 70% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends Ninety (90) Days from Discharge | 35.0823897 | -106.7466905 | ||||||||||||||||
Memorial Sloan-Kettering Cancer Center | Transplant | New York | NY | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceELITE | $286,379 | 50 | Same Rate but 20 Days from Infusion Date | Hospital: $5,588 Med/Surg/ICU/CCU | Professional: 90% of Billed Charges | 90% of Billed Charges | Hospital Inpatient Services and Supplies Shall be Reimbursed at the Lesser of 90% of Billed Charges or a Per Diem Rate of $4,556 or for an Inpatient Stay that Includes Surgery, a Per Diem Rate of $6,817 | Professional Inpatient Services Shall be Reimbursed at 90% of Billed Charges | Hospital and Professional Outpatient Services and Supplies Shall be Reimbursed 90% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Any Pharmaceutical Charges (Revenue Code 636 and 25X) that Exceed $100,000 Shall be Reimbursed at 90% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 40.697403 | -74.1201058 | |||||||||||||
Memorial Sloan-Kettering Cancer Center | Transplant | New York | NY | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceELITE | $286,379 | 50 | Same Rate but 20 Days from Infusion Date | Hospital: $5,588 Med/Surg/ICU/CCU | Professional: 90% of Billed Charges | 90% of Billed Charges | Hospital Inpatient Services and Supplies Shall be Reimbursed at the Lesser of 90% of Billed Charges or a Per Diem Rate of $4,556 or for an Inpatient Stay that Includes Surgery, a Per Diem Rate of $6,817 | Professional Inpatient Services Shall be Reimbursed at 90% of Billed Charges | Hospital and Professional Outpatient Services and Supplies Shall be Reimbursed 90% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Any Pharmaceutical Charges (Revenue Code 636 and 25X) that Exceed $100,000 Shall be Reimbursed at 90% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 40.697403 | -74.1201058 | |||||||||||||
Memorial Sloan-Kettering Cancer Center | Transplant | New York | NY | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceELITE | $139,230 | 35 | Same Rate but 20 Days from Infusion Date | Hospital: $5,588 Med/Surg/ICU/CCU | Professional: 90% of Billed Charges | 90% of Billed Charges | Hospital Inpatient Services and Supplies Shall be Reimbursed at the Lesser of 90% of Billed Charges or a Per Diem Rate of $4,556 or for an Inpatient Stay that Includes Surgery, a Per Diem Rate of $6,817 | Professional Inpatient Services Shall be Reimbursed at 90% of Billed Charges | Hospital and Professional Outpatient Services and Supplies Shall be Reimbursed 90% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Any Pharmaceutical Charges (Revenue Code 636 and 25X) that Exceed $100,000 Shall be Reimbursed at 90% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 40.697403 | -74.1201058 | |||||||||||||
Memorial Sloan-Kettering Cancer Center | Transplant | New York | NY | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $286,379 | 50 | Same Rate but 20 Days from Infusion Date | Hospital: $5,588 Med/Surg/ICU/CCU | Professional: 90% of Billed Charges | 90% of Billed Charges | Hospital Inpatient Services and Supplies Shall be Reimbursed at the Lesser of 90% of Billed Charges or a Per Diem Rate of $4,556 or for an Inpatient Stay that Includes Surgery, a Per Diem Rate of $6,817 | Professional Inpatient Services Shall be Reimbursed at 90% of Billed Charges | Hospital and Professional Outpatient Services and Supplies Shall be Reimbursed 90% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Any Pharmaceutical Charges (Revenue Code 636 and 25X) that Exceed $100,000 Shall be Reimbursed at 90% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 40.697403 | -74.1201058 | ||||||||||||||
Memorial Sloan-Kettering Cancer Center | Transplant | New York | NY | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $286,379 | 50 | Same Rate but 20 Days from Infusion Date | Hospital: $5,588 Med/Surg/ICU/CCU | Professional: 90% of Billed Charges | 90% of Billed Charges | Hospital Inpatient Services and Supplies Shall be Reimbursed at the Lesser of 90% of Billed Charges or a Per Diem Rate of $4,556 or for an Inpatient Stay that Includes Surgery, a Per Diem Rate of $6,817 | Professional Inpatient Services Shall be Reimbursed at 90% of Billed Charges | Hospital and Professional Outpatient Services and Supplies Shall be Reimbursed 90% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Any Pharmaceutical Charges (Revenue Code 636 and 25X) that Exceed $100,000 Shall be Reimbursed at 90% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 40.697403 | -74.1201058 | ||||||||||||||
Memorial Sloan-Kettering Cancer Center | Transplant | New York | NY | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $139,230 | 35 | Same Rate but 20 Days from Infusion Date | Hospital: $5,588 Med/Surg/ICU/CCU | Professional: 90% of Billed Charges | 90% of Billed Charges | Hospital Inpatient Services and Supplies Shall be Reimbursed at the Lesser of 90% of Billed Charges or a Per Diem Rate of $4,556 or for an Inpatient Stay that Includes Surgery, a Per Diem Rate of $6,817 | Professional Inpatient Services Shall be Reimbursed at 90% of Billed Charges | Hospital and Professional Outpatient Services and Supplies Shall be Reimbursed 90% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Any Pharmaceutical Charges (Revenue Code 636 and 25X) that Exceed $100,000 Shall be Reimbursed at 90% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 40.697403 | -74.1201058 | ||||||||||||||
Mount Sinai Medical Center | Transplant | New York | NY | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | $298,575.81 | 40 | $6,061.78 Med/Surg | $8,478.16 ICU/CCU | $3,881.48 Rehab | 100% of Billed Charges or the Case Rate | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 365 Days from Discharge | 40.697403 | -74.1201058 | ||||||||||||||
Mount Sinai Medical Center | Transplant | New York | NY | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceQUALITY | $335,897.77 | 40 | $6,061.78 Med/Surg | $8,478.16 ICU/CCU | $3,881.48 Rehab | 100% of Billed Charges or the Case Rate | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 365 Days from Discharge | 40.697403 | -74.1201058 | ||||||||||||||
Mount Sinai Medical Center | Transplant | New York | NY | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | $232,734.76 | 35 | $6,061.78 Med/Surg | $8,478.16 ICU/CCU | $3,881.48 Rehab | 100% of Billed Charges or the Case Rate | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 365 Days from Discharge | 40.697403 | -74.1201058 | |||||||||||||||
Mount Sinai Medical Center | Transplant | New York | NY | Heart | Heart | Adult | Member's Choice | $493,136.13 | 24 | $6,061.78 Med/Surg | $8,478.16 ICU/CCU | $3,881.48 Rehab | 100% of Billed Charges or the Case Rate | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 40.697403 | -74.1201058 | ||||||||||||||||
Mount Sinai Medical Center | Transplant | New York | NY | Intestine | Intestine | Adult | Programs of Excellence | 80% of Billed Charges | N/A | $6,061.78 Med/Surg | $8,478.16 ICU/CCU | $3,881.48 Rehab | 100% of Billed Charges or the Case Rate | 75% of Billed Charges | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 40.697403 | -74.1201058 | |||||||||||||||||
Mount Sinai Medical Center | Transplant | New York | NY | Kidney | Kidney | Adult | Member's Choice | $198,240.45 | 14 | $6,061.78 Med/Surg | $8,478.16 ICU/CCU | $3,881.48 Rehab | 100% of Billed Charges or the Case Rate | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 40.697403 | -74.1201058 | ||||||||||||||||
Mount Sinai Medical Center | Transplant | New York | NY | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $289,285.24 | 20 | $6,061.78 Med/Surg | $8,478.16 ICU/CCU | $3,881.48 Rehab | 100% of Billed Charges or the Case Rate | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 40.697403 | -74.1201058 | ||||||||||||||||
Mount Sinai Medical Center | Transplant | New York | NY | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | Cadaveric Donor: $474,838.29 | Living Donor: $548.053.24 | Cadaveric: 38 | Living: 38 (Recipient) | Living: 7 (Donor) | $6,061.78 Med/Surg | $8,478.16 ICU/CCU | $3,881.48 Rehab | 100% of Billed Charges or the Case Rate | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 40.697403 | -74.1201058 | |||||||||||||||
Mount Sinai Medical Center | Transplant | New York | NY | Lung | Lung | Adult | Member's Choice | Single: $479,325.26 | Bilateral: $532,110.68 | 20 | $6,061.78 Med/Surg | $8,478.16 ICU/CCU | $3,881.48 Rehab | 100% of Billed Charges or the Case Rate | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 40.697403 | -74.1201058 | ||||||||||||||||
Mount Sinai Medical Center | Transplant | New York | NY | Multi-Visceral | Multi-Visceral | Adult | Member's Choice | 100% of Higher Cost Organ Case Rate, Plus 65% of Lower Cost Organ Case Rate | Equal to Number of Days of Higher Cost Organ | N/A | 100% of Billed Charges or the Case Rate | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 40.697403 | -74.1201058 | ||||||||||||||||
Mount Sinai Medical Center | Transplant | New York | NY | Pancreas | Pancreas | Adult | Member's Choice | $257,608.43 | 15 | $6,061.78 Med/Surg | $8,478.16 ICU/CCU | $3,881.48 Rehab | 100% of Billed Charges or the Case Rate | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 40.697403 | -74.1201058 | ||||||||||||||||
Mount Sinai Medical Center | Transplant | New York | NY | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Member's Choice | $298,575.81 | 40 | $6,061.78 Med/Surg | $8,478.16 ICU/CCU | $3,881.48 Rehab | 100% of Billed Charges or the Case Rate | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 365 Days from Discharge | 40.697403 | -74.1201058 | |||||||||||||||
Mount Sinai Medical Center | Transplant | New York | NY | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Member's Choice | $335,897.77 | 47 | $6,061.78 Med/Surg | $8,478.16 ICU/CCU | $3,881.48 Rehab | 100% of Billed Charges or the Case Rate | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 365 Days from Discharge | 40.697403 | -74.1201058 | |||||||||||||||
Mount Sinai Medical Center | Transplant | New York | NY | Blood/Marrow (Autologous) | Autologous | Pediatric | Member's Choice | $232,734.76 | 35 | $6,061.78 Med/Surg | $8,478.16 ICU/CCU | $3,881.48 Rehab | 100% of Billed Charges or the Case Rate | 75% of Billed Charges | Included in Case Rate | N/A | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 365 Days from Discharge | 40.697403 | -74.1201058 | |||||||||||||||
Mount Sinai Medical Center | Transplant | New York | NY | Heart | Heart | Pediatric | Member's Choice | $493,136.13 | 24 | $6,061.78 Med/Surg | $8,478.16 ICU/CCU | $3,881.48 Rehab | 100% of Billed Charges or the Case Rate | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 40.697403 | -74.1201058 | ||||||||||||||||
Mount Sinai Medical Center | Transplant | New York | NY | Intestine | Intestine | Pediatric | Member's Choice | 80% of Billed Charges | N/A | N/A | 100% of Billed Charges or the Case Rate | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 40.697403 | -74.1201058 | ||||||||||||||||
Mount Sinai Medical Center | Transplant | New York | NY | Kidney | Kidney | Pediatric | Member's Choice | $198,240.45 | 14 | $6,061.78 Med/Surg | $8,478.16 ICU/CCU | $3,881.48 Rehab | 100% of Billed Charges or the Case Rate | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 40.697403 | -74.1201058 | ||||||||||||||||
Mount Sinai Medical Center | Transplant | New York | NY | Liver | Liver | Pediatric | Member's Choice | Cadaveric Donor: $474,838.29 | Living Donor: $548.053.24 | Cadaveric: 38 | Living: 38 (Recipient) | Living: 7 (Donor) | $6,061.78 Med/Surg | $8,478.16 ICU/CCU | $3,881.48 Rehab | 100% of Billed Charges or the Case Rate | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 40.697403 | -74.1201058 | ||||||||||||||||
Mount Sinai Medical Center | Transplant | New York | NY | Multi-Visceral | Multi-Visceral | Pediatric | Member's Choice | 80% of Billed Charges | N/A | N/A | 100% of Billed Charges or the Case Rate | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 40.697403 | -74.1201058 | ||||||||||||||||
Strong Memorial Hospital, Rochester | Transplant | Rochester | NY | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | $226,800 | 40 | Days 41-60: $5,600 Med/Surg, $5,600 ICU/CCU | Day 61-Dishcharge: 60% of Billed Charges | 95% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 43.18616 | -77.6866099 | ||||||||||||||||
Strong Memorial Hospital, Rochester | Transplant | Rochester | NY | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | $268,000 | 40 | Days 41-60: $5,600 Med/Surg $5,600 ICU/CCU | Day 61-Dishcharge: 60% of Billed Charges | 95% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 43.18616 | -77.6866099 | ||||||||||||||||
Strong Memorial Hospital, Rochester | Transplant | Rochester | NY | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $159,500 | 25 | Days 25-45: $5,600 Med/Surg $5,600 ICU/CCU | Day 46-Dishcharge: 60% of Billed Charges | 95% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 43.18616 | -77.6866099 | ||||||||||||||||
Strong Memorial Hospital, Rochester | Transplant | Rochester | NY | Heart | Heart | Adult | Member's Choice | $245,300 | 30 | Days 21-40: $5,500 Med/Surg $5,500 ICU/CCU | Day 41-Dishcharge: 60% of Billed Charges | 95% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost Plus 5% | N/A | Begins at Evaluation | One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 43.18616 | -77.6866099 | ||||||||||||||||
Strong Memorial Hospital, Rochester | Transplant | Rochester | NY | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | $99,200 | 15 | Days 16-35: $5,500 Med/Surg $5,500 ICU/CCU | Day 36-Dishcharge: 60% of Billed Charges | 95% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost Plus 5% | N/A | Begins at Evaluation | One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 43.18616 | -77.6866099 | |||||||||||||||
Strong Memorial Hospital, Rochester | Transplant | Rochester | NY | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $178,700 | 20 | Days 21-40: $5,500 Med/Surg $5,500 ICU/CCU | Day 41-Dishcharge: 60% of Billed Charges | 95% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost Plus 5% | N/A | Begins at Evaluation | One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 43.18616 | -77.6866099 | ||||||||||||||||
Strong Memorial Hospital, Rochester | Transplant | Rochester | NY | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | Cadaveric Donor: $254,800 | Living Donor: $265,800 | 25 | Days 26-45: $5,500 Med/Surg $5,500 ICU/CCU | Day 46-Dishcharge: 60% of Billed Charges | 95% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost Plus 5% | N/A | Begins at Evaluation | One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 43.18616 | -77.6866099 | |||||||||||||||
Strong Memorial Hospital, Rochester | Transplant | Rochester | NY | Pancreas | Pancreas | Adult | Member's Choice | $127,900 | 20 | Days 21-40: $5,500 Med/Surg $5,500 ICU/CCU | Day 41-Dishcharge: 60% of Billed Charges | 95% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost Plus 5% | N/A | Begins at Evaluation | One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 43.18616 | -77.6866099 | ||||||||||||||||
Strong Memorial Hospital, Rochester | Transplant | Rochester | NY | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Member's Choice | $226,800 | 40 | Days 41-60: $5,600 Med/Surg $5,600 ICU/CCU | Day 61-Dishcharge: 60% of Billed Charges | 95% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 43.18616 | -77.6866099 | ||||||||||||||||
Strong Memorial Hospital, Rochester | Transplant | Rochester | NY | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Member's Choice | $268,000 | 40 | Days 41-60: $5,600 Med/Surg $5,600 ICU/CCU | Day 61-Dishcharge: 60% of Billed Charges | 95% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 43.18616 | -77.6866099 | ||||||||||||||||
Strong Memorial Hospital, Rochester | Transplant | Rochester | NY | Blood/Marrow (Autologous) | Autologous | Pediatric | Member's Choice | $159,500 | 25 | Days 25-45: $5,600 Med/Surg $5,600 ICU/CCU | Day 46-Dishcharge: 60% of Billed Charges | 95% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 43.18616 | -77.6866099 | ||||||||||||||||
Strong Memorial Hospital, Rochester | Transplant | Rochester | NY | Heart | Heart | Pediatric | Member's Choice | $245,300 | 30 | Days 21-40: $5,500 Med/Surg, $5,500 ICU/CCU | Day 41-Dishcharge: 60% of Billed Charges | 95% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 105% of Invoice Cost | N/A | Begins at Evaluation | One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 43.18616 | -77.6866099 | ||||||||||||||||
Strong Memorial Hospital, Rochester | Transplant | Rochester | NY | Kidney | Kidney | Pediatric | Member's Choice | $99,200 | 15 | Days 16-35: $5,500 Med/Surg, $5,500 ICU/CCU | Day 36-Dishcharge: 60% of Billed Charges | 95% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 105% of Invoice Cost | N/A | Begins at Evaluation | One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 43.18616 | -77.6866099 | ||||||||||||||||
Strong Memorial Hospital, Rochester | Transplant | Rochester | NY | Kidney/Pancreas | Kidney/Pancreas | Pediatric | Member's Choice | $178,700 | 20 | Days 21-40: $5,500 Med/Surg, $5,500 ICU/CCU | Day 41-Dishcharge: 60% of Billed Charges | 95% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 105% of Invoice Cost | N/A | Begins at Evaluation | One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 43.18616 | -77.6866099 | ||||||||||||||||
Strong Memorial Hospital, Rochester | Transplant | Rochester | NY | Liver | Liver | Pediatric | Member's Choice | Cadaveric Donor: $254,800 | Living Donor: $265,800 | 25 | Days 26-45: $5,500 Med/Surg, $5,500 ICU/CCU | Day 46-Dishcharge: 60% of Billed Charges | 95% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 105% of Invoice Cost | N/A | Begins at Evaluation | One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 43.18616 | -77.6866099 | ||||||||||||||||
Strong Memorial Hospital, Rochester | Transplant | Rochester | NY | Pancreas | Pancreas | Pediatric | Member's Choice | $127,900 | 20 | Days 21-40: $5,500 Med/Surg, $5,500 ICU/CCU | Day 41-Dishcharge: 60% of Billed Charges | 95% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 105% of Invoice Cost | N/A | Begins at Evaluation | One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 43.18616 | -77.6866099 | ||||||||||||||||
Arthur G James Cancer Hospital | Transplant | Columbus | OH | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceSELECT | $199,500 | N/A | N/A | 75% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Invoice Cost | If Billed Charges Exceed $472,500, Payment will be the Transplant Case Rate, Plus 55% of the Excess Charges | Begins at Evaluation | Begins on the Earlier of Transplant Admission, Preparatory Therapy, or Transplant Event and Ends at Discharge | Ends One (1) Year from Discharge | 39.9828667 | -83.1312539 | |||||||||||||||
Arthur G James Cancer Hospital | Transplant | Columbus | OH | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceSELECT | $236,250 | N/A | N/A | 75% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Invoice Cost | If Billed Charges Exceed $603,750, Payment will be the Transplant Case Rate, Plus 55% of the Excess Charges | Begins at Evaluation | Begins on the Earlier of Transplant Admission, Preparatory Therapy, or Transplant Event and Ends at Discharge | Ends One (1) Year from Discharge | 39.9828667 | -83.1312539 | |||||||||||||||
Arthur G James Cancer Hospital | Transplant | Columbus | OH | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceSELECT | $126,000 | N/A | N/A | 75% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Invoice Cost | If Billed Charges Exceed $341,250, Payment will be the Transplant Case Rate, Plus 55% of the Excess Charges | Begins at Evaluation | Begins on the Earlier of Transplant Admission, Preparatory Therapy, or Transplant Event and Ends at Discharge | Ends One (1) Year from Discharge | 39.9828667 | -83.1312539 | |||||||||||||||
Cincinnati Children's Hospital Medical Center | Transplant | Cincinnati | OH | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $185,000 | 40 | $2,500 Med/Surg | $3,500 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy or, if no Ablative Therapy One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 39.9828667 | -83.1312539 | ||||||||||||||||
Cincinnati Children's Hospital Medical Center | Transplant | Cincinnati | OH | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $220,000 | 45 | $2,500 Med/Surg | $3,500 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy or, if no Ablative Therapy One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 39.9828667 | -83.1312539 | ||||||||||||||||
Cincinnati Children's Hospital Medical Center | Transplant | Cincinnati | OH | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $142,000 | 35 | $2,500 Med/Surg | $3,500 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy or, if no Ablative Therapy One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 39.9828667 | -83.1312539 | ||||||||||||||||
Cincinnati Children's Hospital Medical Center | Transplant | Cincinnati | OH | Heart | Heart | Pediatric | Member's Choice | $169,000 | 20 | $2,500 Med/Surg | $3,500 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 105% of Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 39.9828667 | -83.1312539 | ||||||||||||||||
Cincinnati Children's Hospital Medical Center | Transplant | Cincinnati | OH | Heart/Lung | Heart/Lung | Pediatric | Member's Choice | $269,500 | 35 | $2,500 Med/Surg | $3,500 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 105% of Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 39.9828667 | -83.1312539 | ||||||||||||||||
Cincinnati Children's Hospital Medical Center | Transplant | Cincinnati | OH | Intestine | Intestine | Pediatric | Member's Choice | 70% of Billed Charges | N/A | N/A | N/A | 80% of Billed Charges | Included in Case Rate | 105% of Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 39.9828667 | -83.1312539 | ||||||||||||||||
Cincinnati Children's Hospital Medical Center | Transplant | Cincinnati | OH | Intestine/Liver | Intestine/Liver | Pediatric | Member's Choice | 70% of Billed Charges | N/A | N/A | N/A | 80% of Billed Charges | Included in Case Rate | 105% of Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 39.9828667 | -83.1312539 | ||||||||||||||||
Cincinnati Children's Hospital Medical Center | Transplant | Cincinnati | OH | Kidney | Kidney | Pediatric | Member's Choice | $78,000 | 12 | $2,500 Med/Surg | $3,500 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 105% of Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 39.9828667 | -83.1312539 | ||||||||||||||||
Cincinnati Children's Hospital Medical Center | Transplant | Cincinnati | OH | Kidney/Liver | Kidney/Liver | Pediatric | Member's Choice | 70% of Billed Charges | N/A | N/A | N/A | 80% of Billed Charges | Included in Case Rate | 105% of Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 39.9828667 | -83.1312539 | ||||||||||||||||
Cincinnati Children's Hospital Medical Center | Transplant | Cincinnati | OH | Liver | Liver | Pediatric | Programs of Excellence | $185,000 | 20 | $2,500 Med/Surg | $3,500 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 105% of Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 39.9828667 | -83.1312539 | ||||||||||||||||
Cincinnati Children's Hospital Medical Center | Transplant | Cincinnati | OH | Lung | Lung | Pediatric | Programs of Excellence | $185,000 | 23 | $2,500 Med/Surg | $3,500 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 105% of Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 39.9828667 | -83.1312539 | ||||||||||||||||
Ohio State University Medical Center | Transplant | Columbus | OH | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | $434,000 | 25 | $10,000 | 70% of Billed Charges | 60% of Billed Charges | Included in Case Rate | 65% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.9828667 | -83.1312539 | |||||||||||||||
Ohio State University Medical Center | Transplant | Columbus | OH | Kidney | Kidney | Adult | Programs of Excellence | PerformanceELITE | Cadaveric Donor: $175,000 | Living Donor: $165,000 | 10 | $10,000 | 70% of Billed Charges | 60% of Billed Charges | Included in Case Rate | 65% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.9828667 | -83.1312539 | |||||||||||||||
Ohio State University Medical Center | Transplant | Columbus | OH | Pancreas | Pancreas | Adult | Member's Choice | $150,000 | 20 | $10,000 | 70% of Billed Charges | 60% of Billed Charges | Included in Case Rate | 65% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.9828667 | -83.1312539 | ||||||||||||||||
Ohio State University Medical Center | Transplant | Columbus | OH | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceQUALITY | $250,000 | 20 | $10,000 | 70% of Billed Charges | 60% of Billed Charges | Included in Case Rate | 65% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.9828667 | -83.1312539 | |||||||||||||||
Ohio State University Medical Center | Transplant | Columbus | OH | Liver | Liver | Adult | Programs of Excellence | PerformanceSELECT | $234,000 | 20 | $10,000 | 70% of Billed Charges | 60% of Billed Charges | Included in Case Rate | 65% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.9828667 | -83.1312539 | |||||||||||||||
Ohio State University Medical Center | Transplant | Columbus | OH | Lung | Lung | Adult | Programs of Excellence | PerformanceSELECT | Single: $270,000 | Bilateral: $275,000 | 30 | $10,000 | 70% of Billed Charges | 60% of Billed Charges | Included in Case Rate | 65% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.9828667 | -83.1312539 | |||||||||||||||
The Jewish Hospital - Cincinnati | Transplant | Cincinnati | OH | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $129,725 | 25 | $3,153 Med/Surg | $3,755 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.136319 | -84.6106124 | ||||||||||||||||
The Jewish Hospital - Cincinnati | Transplant | Cincinnati | OH | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | $220,393 | 30 | $3,153 Med/Surg | $3,755 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.136319 | -84.6106124 | ||||||||||||||||
The Jewish Hospital - Cincinnati | Transplant | Cincinnati | OH | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | $276,187 | 40 | $3,153 Med/Surg | $3,755 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.136319 | -84.6106124 | ||||||||||||||||
The Jewish Hospital - Cincinnati | Transplant | Cincinnati | OH | Tandem (Auto-to-Auto) | Tandem Auto to Auto | Adult | Member's Choice | $233,505 | 1st: 25 | 2nd: 25 | $3,153 Med/Surg | $3,755 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.136319 | -84.6106124 | ||||||||||||||||
The Jewish Hospital - Cincinnati | Transplant | Cincinnati | OH | Tandem (Auto-to-Allo, Related) | Tandem Auto to Allo | Adult | Member's Choice | $294,269 | 1st: 25 | 2nd: 30 | $3,153 Med/Surg | $3,755 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.136319 | -84.6106124 | ||||||||||||||||
The Jewish Hospital - Cincinnati | Transplant | Cincinnati | OH | Tandem (Auto-to-Allo, Unrelated) | Tandem Auto to Allo | Adult | Member's Choice | $348,723 | 1st: 25 | 2nd: 30 | $3,153 Med/Surg | $3,755 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.136319 | -84.6106124 | ||||||||||||||||
University Hospitals Case Medical Center | Transplant | Cleveland | OH | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $157,385 | 30 | Hospital: $5,474 | Professional: 75% of Billed Charges | 85% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 58% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.4975107 | -81.7760709 | ||||||||||||||||
University Hospitals Case Medical Center | Transplant | Cleveland | OH | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | $320,245 | 40 | Hospital: $5,693 | Professional: 75% of Billed Charges | 85% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 58% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.4975107 | -81.7760709 | ||||||||||||||||
University Hospitals Case Medical Center | Transplant | Cleveland | OH | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | $320,245 | 40 | Hospital: $5,693 | Professional: 75% of Billed Charges | 85% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 58% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.4975107 | -81.7760709 | ||||||||||||||||
University Hospitals Case Medical Center | Transplant | Cleveland | OH | Heart | Heart | Adult | Member's Choice | $320,245 | 27 | Hospital: $5,693 | Professional: 75% of Billed Charges | 85% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 58% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.4975107 | -81.7760709 | ||||||||||||||||
University Hospitals Case Medical Center | Transplant | Cleveland | OH | Kidney | Kidney | Adult | Member's Choice | $145,177 | 12 | Hospital: $5,693 | Professional: 75% of Billed Charges | 85% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 58% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.4975107 | -81.7760709 | ||||||||||||||||
University Hospitals Case Medical Center | Transplant | Cleveland | OH | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $256,197 | 18 | Hospital: $5,693 | Professional: 75% of Billed Charges | 85% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 58% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.4975107 | -81.7760709 | ||||||||||||||||
University Hospitals Case Medical Center | Transplant | Cleveland | OH | Liver | Liver | Adult | Member's Choice | $263,312 | 20 | Hospital: $5,693 | Professional: 75% of Billed Charges | 85% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 58% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.4975107 | -81.7760709 | ||||||||||||||||
University Hospitals Case Medical Center | Transplant | Cleveland | OH | Lung | Lung | Adult | Member's Choice | $298,896 | 25 | Hospital: $5,693 | Professional: 75% of Billed Charges | 85% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 58% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.4975107 | -81.7760709 | ||||||||||||||||
University Hospitals Case Medical Center | Transplant | Cleveland | OH | Pancreas | Pancreas | Adult | Member's Choice | $167,952 | 16 | Hospital: $5,693 | Professional: 75% of Billed Charges | 85% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 58% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 41.4975107 | -81.7760709 | ||||||||||||||||
University Hospitals Case Medical Center | Transplant | Cleveland | OH | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | 75% of Billed Charges | 30 | N/A | N/A | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier Days have Expired | Ends One (1) Year from Discharge | 41.4975107 | -81.7760709 | ||||||||||||||||
University Hospitals Case Medical Center | Transplant | Cleveland | OH | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | 75% of Billed Charges | 35 | N/A | N/A | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier Days have Expired | Ends One (1) Year from Discharge | 41.4975107 | -81.7760709 | ||||||||||||||||
University Hospitals Case Medical Center | Transplant | Cleveland | OH | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | 75% of Billed Charges | 40 | N/A | N/A | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier Days have Expired | Ends One (1) Year from Discharge | 41.4975107 | -81.7760709 | ||||||||||||||||
University Hospitals Case Medical Center | Transplant | Cleveland | OH | Kidney | Kidney | Pediatric | Member's Choice | 75% of Billed Charges | 35 | N/A | N/A | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 41.4975107 | -81.7760709 | ||||||||||||||||
University Hospitals Case Medical Center | Transplant | Cleveland | OH | Tandem (Auto-to-Auto) | Tandem Auto to Auto | Pediatric | Programs of Excellence | 75% of Billed Charges | 1st: 30 | 2nd: 30 | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier Days have Expired | Ends One (1) Year from Discharge | 41.4975107 | -81.7760709 | |||||||||||||||||||
University Hospitals Case Medical Center | Transplant | Cleveland | OH | Tandem (Auto-to-Auto) | Tandem Auto to Auto | Adult | Member's Choice | 1st: $163,679 | 2nd: $120,982 | 30 | Included in Case Rate | Included in Case Rate | 58% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier Days have Expired | Ends One (1) Year from Discharge | 41.4975107 | -81.7760709 | |||||||||||||||||||
University of Cincinnati Medical Center | Transplant | Cincinnati | OH | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | Hospital: $168,538 | Professional: 75% of Billed Charges | 30 | $2,677 Med/Surg | $3,348 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | Reimbursed at 75% of Billed Charges | N/A | Begins at Evaluation | Begins on the First Day of Ablative Therapy and Ends when the Inlier Days have Expired | Ends One (1) Year from Discharge | 39.136319 | -84.6106124 | |||||||||||||||
University of Cincinnati Medical Center | Transplant | Cincinnati | OH | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | Hospital: $237,006 | Professional: 75% of Billed Charges | 30 | $2,677 Med/Surg | $3,348 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | Reimbursed at 75% of Billed Charges | N/A | Begins at Evaluation | Begins on the First Day of Ablative Therapy and Ends when the Inlier Days have Expired | Ends One (1) Year from Discharge | 39.136319 | -84.6106124 | |||||||||||||||
University of Cincinnati Medical Center | Transplant | Cincinnati | OH | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | Hospital: $110,603 | Professional: 75% of Billed Charges | 30 | $2,677 Med/Surg | $3,348 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | Reimbursed at 75% of Billed Charges | N/A | Begins at Evaluation | Begins on the First Day of Ablative Therapy and Ends when the Inlier Days have Expired | Ends One (1) Year from Discharge | 39.136319 | -84.6106124 | |||||||||||||||
University of Cincinnati Medical Center | Transplant | Cincinnati | OH | Heart | Heart | Adult | Member's Choice | Hospital: $262,287 | Professional: 75% of Billed Charges | 25 | $2,677 Med/Surg | $3,348 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 75% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.136319 | -84.6106124 | ||||||||||||||||
University of Cincinnati Medical Center | Transplant | Cincinnati | OH | Islet | Islet | Adult | Member's Choice | Hospital: 70% of Billed Charges | Professional: 75% of Billed Charges | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | N/A | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.136319 | -84.6106124 | ||||||||||||||||
University of Cincinnati Medical Center | Transplant | Cincinnati | OH | Kidney | Kidney | Adult | Programs of Excellence | PerformanceELITE | Cadaveric Donor, Hospital: $106,165 | Cadaveric Donor, Professional: 75% of Billed Charges | Living Donor, Hospital: $81,943 | Living Donor, Professional: 75% of Billed Charges | 12 | $2,677 Med/Surg | $3,348 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 75% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.136319 | -84.6106124 | |||||||||||||||
University of Cincinnati Medical Center | Transplant | Cincinnati | OH | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $131,766 | Professional: 75% of Billed Charges | 15 | $2,677 Med/Surg | $3,348 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 75% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.136319 | -84.6106124 | |||||||||||||||
University of Cincinnati Medical Center | Transplant | Cincinnati | OH | Liver | Liver | Adult | Member's Choice | Cadaveric Donor, Hospital: $210,672 | Cadaveric Donor, Professional: 75% of Billed Charges | Living Donor, Hospital: $250,649 | Living Donor, Professional: 75% of Billed Charges | 25 | $2,677 Med/Surg | $3,348 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 75% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.136319 | -84.6106124 | ||||||||||||||||
University of Cincinnati Medical Center | Transplant | Cincinnati | OH | Pancreas | Pancreas | Adult | Member's Choice | Hospital: $113,877 | Professional: 75% of Billed Charges | 15 | $2,677 Med/Surg | $3,348 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 75% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.136319 | -84.6106124 | ||||||||||||||||
Integris Baptist Medical Center | Transplant | Oklahoma City | OK | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | $130,000 | 20 | $2,500 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 75% of Billed Charges | If Billed Charges Exceed $260,000, Payment will be the Transplant Case Rate Plus 70% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 35.4825666 | -97.6196227 | |||||||||||||||
Integris Baptist Medical Center | Transplant | Oklahoma City | OK | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | $58,500 | 12 | $2,500 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 75% of Billed Charges | If Billed Charges Exceed $117,000, Payment will be the Transplant Case Rate Plus 70% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 35.4825666 | -97.6196227 | |||||||||||||||
Integris Baptist Medical Center | Transplant | Oklahoma City | OK | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceQUALITY | $115,000 | 15 | $2,500 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 75% of Billed Charges | If Billed Charges Exceed $230,000, Payment will be the Transplant Case Rate Plus 70% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 35.4825666 | -97.6196227 | |||||||||||||||
Integris Baptist Medical Center | Transplant | Oklahoma City | OK | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | $144,500 | 20 | $2,500 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | If Billed Charges Exceed $289,000, Payment will be the Transplant Case Rate Plus 70% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 35.4825666 | -97.6196227 | |||||||||||||||
Integris Baptist Medical Center | Transplant | Oklahoma City | OK | Lung | Lung | Adult | Programs of Excellence | PerformanceELITE | Single: $130,000 | Bilateral: $178,000 | 25 | $2,500 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | If Billed Charges Exceed $260,000 (Single) or $356,000 (Bilateral), Payment will be the Transplant Case Rate Plus 70% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 35.4825666 | -97.6196227 | |||||||||||||||
Integris Baptist Medical Center | Transplant | Oklahoma City | OK | Pancreas | Pancreas | Adult | Member's Choice | $75,000 | 15 | $2,500 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | If Billed Charges Exceed $150,000, Payment will be the Transplant Case Rate Plus 70% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 35.4825666 | -97.6196227 | ||||||||||||||||
Integris Baptist Medical Center | Transplant | Oklahoma City | OK | Liver | Liver | Pediatric | Member's Choice | $144,500 | 20 | $2,500 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | If Billed Charges Exceed $289,000, Payment will be the Transplant Case Rate Plus 70% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 35.4825666 | -97.6196227 | ||||||||||||||||
Northwest Marrow Transplant Program (Oregon Health & Science University) | Transplant | Portland | OR | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceSELECT | $136,696 | N/A | 65% of Billed Charges | N/A | 87% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | If Billed Charges Exceed $248,787, Payment will be the Transplant Case Rate Plus 68% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 45.5426915 | -122.7245379 | ||||||||||||||
Northwest Marrow Transplant Program (Oregon Health & Science University) | Transplant | Portland | OR | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceSELECT | $153,380 | N/A | 65% of Billed Charges | N/A | 87% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | If Billed Charges Exceed $279,152, Payment will be the Transplant Case Rate Plus 68% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 45.5426915 | -122.7245379 | ||||||||||||||
Northwest Marrow Transplant Program (Oregon Health & Science University) | Transplant | Portland | OR | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceSELECT | $141,045 | N/A | 65% of Billed Charges | N/A | 87% of Billed Charges | 70% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | If Billed Charges Exceed $256,702, Payment will be the Transplant Case Rate Plus 68% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 45.5426915 | -122.7245379 | ||||||||||||||
Northwest Marrow Transplant Program (Oregon Health & Science University) | Transplant | Portland | OR | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $161,453 | N/A | 65% of Billed Charges | N/A | 87% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | If Billed Charges Exceed $293,844, Payment will be the Transplant Case Rate Plus 68% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 45.5426915 | -122.7245379 | |||||||||||||||
Northwest Marrow Transplant Program (Oregon Health & Science University) | Transplant | Portland | OR | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $218,480 | N/A | 65% of Billed Charges | N/A | 87% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | If Billed Charges Exceed $397,634, Payment will be the Transplant Case Rate Plus 68% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 45.5426915 | -122.7245379 | |||||||||||||||
Northwest Marrow Transplant Program (Oregon Health & Science University) | Transplant | Portland | OR | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $233,568 | N/A | 65% of Billed Charges | N/A | 87% of Billed Charges | 70% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | If Billed Charges Exceed $425,094, Payment will be the Transplant Case Rate Plus 68% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 45.5426915 | -122.7245379 | |||||||||||||||
Northwest Marrow Transplant Program (Oregon Health & Science University) | Transplant | Portland | OR | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Adult | Programs of Excellence | PerformanceSELECT | 1st Infusion: $136,696| 2nd Infusion: $107,443 | N/A | 65% of Billed Charges | N/A | 87% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | If Billed Charges Exceed $248,787 for the 1st Infusion and $195,546 for the 2nd Infusion, Payment will be the Transplant Case Rate Plus 68% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 45.5426915 | -122.7245379 | ||||||||||||||
Northwest Marrow Transplant Program (Oregon Health & Science University) | Transplant | Portland | OR | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Pediatric | Programs of Excellence | 1st Infusion: $161,453 | 2nd Infusion: $126,902 | N/A | 65% of Billed Charges | N/A | 87% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | If Billed Charges Exceed $293,844 for the 1st Infusion and $230,962 for the 2nd Infusion, Payment will be the Transplant Case Rate Plus 68% of the Excess Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 45.5426915 | -122.7245379 | |||||||||||||||
Oregon Health & Science University | Transplant | Portland | OR | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | Cadaveric Donor: $112,623 | Living Donor: $116,775 | N/A | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | Cadaveric Donor: Charges that Exceed $202,721 Shall be Reimbursed at 65% of Billed Charges | Living Donor: Charges that Exceed $210,195 Shall be Reimbursed at 65% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 45.5426915 | -122.7245379 | ||||||||||||||||
Oregon Health & Science University | Transplant | Portland | OR | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $207,600 | N/A | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | Charges that Exceed $373,680 Shall be Reimbursed at 65% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 45.5426915 | -122.7245379 | |||||||||||||||||
Oregon Health & Science University | Transplant | Portland | OR | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | $193,068 | N/A | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | Charges that Exceed $328,216 Shall be Reimbursed at 65% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 45.5426915 | -122.7245379 | ||||||||||||||||
Oregon Health & Science University | Transplant | Portland | OR | Heart | Heart | Adult | Member's Choice | $290,000 | N/A | N/A | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | Charges that Exceed $522,000 Shall be Reimbursed at 65% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 45.5426915 | -122.7245379 | ||||||||||||||||
Oregon Health & Science University | Transplant | Portland | OR | Kidney | Kidney | Pediatric | Programs of Excellence | Cadaveric Donor: $112,623 | Living Donor: $116,775 | N/A | N/A | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | Cadaveric Donor: Charges that Exceed $202,721 Shall be Reimbursed at 65% of Billed Charges | Living Donor: Charges that Exceed $210,195 Shall be Reimbursed at 65% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 45.5426915 | -122.7245379 | ||||||||||||||||
Children's Hospital of Philadelphia | Transplant | Philadelphia | PA | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | Hospital: $205,337 | Professional: 75% of Billed Charges | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 65% of Billed Charges in Excess of the Stop Loss Threshold ($316,035) | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | ||||||||||||||||
Children's Hospital of Philadelphia | Transplant | Philadelphia | PA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | Hospital: $281,389 | Professional: 75% of Billed Charges | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 65% of Billed Charges in Excess of the Stop Loss Threshold ($432,646) | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | ||||||||||||||||
Children's Hospital of Philadelphia | Transplant | Philadelphia | PA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | Hospital: $342,230 | Professional: 75% of Billed Charges | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 65% of Billed Charges in Excess of the Stop Loss Threshold ($527,288) | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | ||||||||||||||||
Children's Hospital of Philadelphia | Transplant | Philadelphia | PA | Heart | Heart | Pediatric | Programs of Excellence | Hospital: $295,754 |Professional: 75% of Billed Charges | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 65% of Billed Charges in Excess of the Stop Loss Threshold ($456,307) | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | ||||||||||||||||
Children's Hospital of Philadelphia | Transplant | Philadelphia | PA | Heart/Lung | Heart/Lung | Pediatric | Member's Choice | Hospital: $329,555 | Professional: 75% of Billed Charges | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 65% of Billed Charges in Excess of the Stop Loss Threshold ($507,008) | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | ||||||||||||||||
Children's Hospital of Philadelphia | Transplant | Philadelphia | PA | Kidney | Kidney | Pediatric | Programs of Excellence | Hospital: $144,497 | Professional: 75% of Billed Charges | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 65% of Billed Charges in Excess of the Stop Loss Threshold ($221,393) | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | ||||||||||||||||
Children's Hospital of Philadelphia | Transplant | Philadelphia | PA | Liver | Liver | Pediatric | Programs of Excellence | Hospital: $228,154 | Professional: 75% of Billed Charges | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 65% of Billed Charges in Excess of the Stop Loss Threshold ($351,535) | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | ||||||||||||||||
Children's Hospital of Philadelphia | Transplant | Philadelphia | PA | Lung | Lung | Pediatric | Programs of Excellence | Hospital: $312,655 | Professional: 75% of Billed Charges | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 65% of Billed Charges in Excess of the Stop Loss Threshold ($481,658) | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | ||||||||||||||||
Hospital of the University of Pennsylvania | Transplant | Philadelphia | PA | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $147,376 | Professional: 224% of Current Medicare RBRVS for the Philadelphia Geographic Area | 30 | $3,126 ICU/CCU | $2,431 Med/Surg | 100% of Billed Charges | Hospital: 67% of Billed Charges | Professional: 160% of Current Medicare RBRVS for the Philadelphia Geographic Area | Reimbursed at the Pre-Transplant Rate | N/A | 40% of Billed Charges in Excess of 2.5 Times the Case Rate | Begins at Evaluation | Begins on the Day of Mobilization and Ends at Discharge | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | |||||||||||||||
Hospital of the University of Pennsylvania | Transplant | Philadelphia | PA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $255,970 | Professional: 224% of Current Medicare RBRVS for the Philadelphia Geographic Area | 35 | $3,126 ICU/CCU | $2,431 Med/Surg | 100% of Billed Charges | Hospital: 67% of Billed Charges | Professional: 160% of Current Medicare RBRVS for the Philadelphia Geographic Area | Reimbursed at the Pre-Transplant Rate | N/A | 40% of Billed Charges in Excess of 2.5 Times the Case Rate | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | |||||||||||||||
Hospital of the University of Pennsylvania | Transplant | Philadelphia | PA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $255,970 | Professional: 224% of Current Medicare RBRVS for the Philadelphia Geographic Area | 40 | $3,126 ICU/CCU | $2,431 Med/Surg | 100% of Billed Charges | Hospital: 67% of Billed Charges | Professional: 160% of Current Medicare RBRVS for the Philadelphia Geographic Area | Reimbursed at the Pre-Transplant Rate | N/A | 40% of Billed Charges in Excess of 2.5 Times the Case Rate | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | |||||||||||||||
Hospital of the University of Pennsylvania | Transplant | Philadelphia | PA | Heart/Lung | Heart/Lung | Adult | Member's Choice | Hospital: $504,183 | Professional: 224% of Current Medicare RBRVS for the Philadelphia Geographic Area | 30 | $3,126 ICU/CCU | $2,431 Med/Surg | 100% of Billed Charges | Hospital: 67% of Billed Charges | Professional: 160% of Current Medicare RBRVS for the Philadelphia Geographic Area | Included in Case Rate | Reimbursed at Invoice Cost | 40% of Billed Charges in Excess of 2.5 Times the Case Rate | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | ||||||||||||||||
Hospital of the University of Pennsylvania | Transplant | Philadelphia | PA | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $459,173 | Professional: 224% of Current Medicare RBRVS for the Philadelphia Geographic Area | 25 | $3,126 ICU/CCU | $2,431 Med/Surg | 100% of Billed Charges | Hospital: 67% of Billed Charges | Professional: 160% of Current Medicare RBRVS for the Philadelphia Geographic Area | Included in Case Rate | Reimbursed at Invoice Cost | 40% of Billed Charges in Excess of 2.5 Times the Case Rate | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | |||||||||||||||
Hospital of the University of Pennsylvania | Transplant | Philadelphia | PA | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $155,133 | Professional: 224% of Current Medicare RBRVS for the Philadelphia Geographic Area | 20 | $3,126 ICU/CCU | $2,431 Med/Surg | 100% of Billed Charges | Hospital: 67% of Billed Charges | Professional: 160% of Current Medicare RBRVS for the Philadelphia Geographic Area | Included in Case Rate | Reimbursed at Invoice Cost | 40% of Billed Charges in Excess of 2.5 Times the Case Rate | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | |||||||||||||||
Hospital of the University of Pennsylvania | Transplant | Philadelphia | PA | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $201,674 | Professional: 224% of Current Medicare RBRVS for the Philadelphia Geographic Area | 20 | $3,126 ICU/CCU | $2,431 Med/Surg | 100% of Billed Charges | Hospital: 67% of Billed Charges | Professional: 160% of Current Medicare RBRVS for the Philadelphia Geographic Area | Included in Case Rate | Reimbursed at Invoice Cost | 40% of Billed Charges in Excess of 2.5 Times the Case Rate | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | |||||||||||||||
Hospital of the University of Pennsylvania | Transplant | Philadelphia | PA | Liver | Liver | Adult | Programs of Excellence | PerformanceELITE | Hospital: $279,241 | Professional: 224% of Current Medicare RBRVS for the Philadelphia Geographic Area | 35 | $3,126 ICU/CCU | $2,431 Med/Surg | 100% of Billed Charges | Hospital: 67% of Billed Charges | Professional: 160% of Current Medicare RBRVS for the Philadelphia Geographic Area | Included in Case Rate | Reimbursed at Invoice Cost | 40% of Billed Charges in Excess of 2.5 Times the Case Rate | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | |||||||||||||||
Hospital of the University of Pennsylvania | Transplant | Philadelphia | PA | Lung | Lung | Adult | Member's Choice | Bilateral Lung Hospital: $364,562 | Bilateral Lung Professional: 224% of Current Medicare RBRVS for the Philadelphia Geographic Area | Single Lung Hospital: $345,493 | Single Lung Professional: 224% of Current Medicare RBRVS for the Philadelphia Geographic Area | 35 | $3,126 ICU/CCU | $2,431 Med/Surg | 100% of Billed Charges | Hospital: 67% of Billed Charges | Professional: 160% of Current Medicare RBRVS for the Philadelphia Geographic Area | Included in Case Rate | Reimbursed at Invoice Cost | 40% of Billed Charges in Excess of 2.5 Times the Case Rate | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | ||||||||||||||||
Hospital of the University of Pennsylvania | Transplant | Philadelphia | PA | Pancreas | Pancreas | Adult | Member's Choice | Hospital: $147,377 | Professional: 224% of Current Medicare RBRVS for the Philadelphia Geographic Area | 20 | $4,400 ICU/CCU | $3,422 Med/Surg | 100% of Billed Charges | Hospital: 67% of Billed Charges | Professional: 224% of Current Medicare RBRVS for the Philadelphia Geographic Area | Included in Case Rate | Reimbursed at Invoice Cost | 40% of Billed Charges in Excess of 2.5 Times the Case Rate | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | ||||||||||||||||
Thomas Jefferson University Hospital | Transplant | Philadelphia | PA | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $147,192 | Professional: $12,360 | 28 | 65% of Billed Charges | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | |||||||||||||||
Thomas Jefferson University Hospital | Transplant | Philadelphia | PA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $197,260 | Professional: $13,102 | 35 | 65% of Billed Charges | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | |||||||||||||||
Thomas Jefferson University Hospital | Transplant | Philadelphia | PA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $225,001 | Professional: $27,809 | 30 | 65% of Billed Charges | 80% of Billed Charges | 70% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | |||||||||||||||
Thomas Jefferson University Hospital | Transplant | Philadelphia | PA | Blood/Marrow (Tandem Autologous-to-Autologous) | Tandem Auto to Auto | Adult | Member's Choice | 1st Auto: $104,495 | 2nd Auto: $52,247 | 28 | 28 | 65% of Billed Charges | 80% of Billed Charges | 70% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | ||||||||||||||||
Thomas Jefferson University Hospital | Transplant | Philadelphia | PA | Heart | Heart | Adult | Member's Choice | Hospital: $226,967 | Professional: $38,202 | 30 | 65% of Billed Charges | 80% of Billed Charges | 70% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | ||||||||||||||||
Thomas Jefferson University Hospital | Transplant | Philadelphia | PA | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | Cadaveric Donor Hospital: $102,248 | Cadaveric Donor Professional: $12,809 | Living Donor Hospital: $123,596 | Living Donor Professional: $16,067 | 8 | 65% of Billed Charges | 80% of Billed Charges | 70% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | |||||||||||||||
Thomas Jefferson University Hospital | Transplant | Philadelphia | PA | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $143,259 | Professional: $25,281 | 12 | 65% of Billed Charges | 80% of Billed Charges | 70% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | |||||||||||||||
Thomas Jefferson University Hospital | Transplant | Philadelphia | PA | Liver | Liver | Adult | Programs of Excellence | PerformanceELITE | Cadaveric Donor Hospital: $217,978 | Cadaveric Donor Professional: $41,798 | Living Donor Hospital: $234,832 | Living Donor Professional: $48,540 | Cadaveric Donor: 20 | Living Donor: 30 | 65% of Billed Charges | 80% of Billed Charges | 70% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | |||||||||||||||
Thomas Jefferson University Hospital | Transplant | Philadelphia | PA | Pancreas | Pancreas | Adult | Member's Choice | Hospital: $102,248 | Professional: $21,910 | 18 | 65% of Billed Charges | 80% of Billed Charges | 70% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends One (1) Year from Discharge | 40.0024768 | -75.1882393 | ||||||||||||||||
Medical University of South Carolina | Transplant | Columbia | SC | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceSELECT | $106,000 | N/A | N/A | Lesser of 95% | 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges in Excess of the Threshold ($159,000) | Begins at Evaluation | Begins on the Day of Mobilization Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 34.037489 | -81.0077761 | |||||||||||||||
Medical University of South Carolina | Transplant | Columbia | SC | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceSELECT | $153,700 | N/A | N/A | Lesser of 95% | 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges in Excess of the Threshold ($230,550) | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 34.037489 | -81.0077761 | |||||||||||||||
Medical University of South Carolina | Transplant | Columbia | SC | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceSELECT | $196,100 | N/A | N/A | Lesser of 95% | 75% of Billed Charges | Charges Reimbursed at Cost Pass Through | Charges Reimbursed at Invoice Cost | 70% of Billed Charges in Excess of the Threshold ($294,150) | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 34.037489 | -81.0077761 | |||||||||||||||
Medical University of South Carolina | Transplant | Columbia | SC | Heart | Heart | Adult | Member's Choice | $143,100 | N/A | N/A | Lesser of 95% | 75% of Billed Charges | Charges Reimbursed at Cost Pass Through | Reimbursed at 55% of Billed Charges | 70% of Billed Charges in Excess of the Threshold ($286,200) | Begins at Evaluation | Begins One (1) Day Prior to Admission and Ends at Discharge | Ends One (1) Year from Discharge | 34.037489 | -81.0077761 | ||||||||||||||||
Medical University of South Carolina | Transplant | Columbia | SC | Kidney | Kidney | Adult | Programs of Excellence | PerformanceELITE | $47,700 | N/A | N/A | Lesser of 95% | 75% of Billed Charges | Charges Reimbursed at Cost Pass Through | Reimbursed at 55% of Billed Charges | 70% of Billed Charges in Excess of the Threshold ($95,400) | Begins at Evaluation | Begins One (1) Day Prior to Admission and Ends at Discharge | Ends One (1) Year from Discharge | 34.037489 | -81.0077761 | |||||||||||||||
Medical University of South Carolina | Transplant | Columbia | SC | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceELITE | $127,700 | N/A | N/A | Lesser of 95% | 75% of Billed Charges | Charges Reimbursed at Cost Pass Through | Reimbursed at 55% of Billed Charges | 70% of Billed Charges in Excess of the Threshold ($201,400) | Begins at Evaluation | Begins One (1) Day Prior to Admission and Ends at Discharge | Ends One (1) Year from Discharge | 34.037489 | -81.0077761 | |||||||||||||||
Medical University of South Carolina | Transplant | Columbia | SC | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | Cadaveric Donor: $159,000 | Living Donor: 70% of Billed Charges | N/A | N/A | Lesser of 95% | 75% of Billed Charges | Cadaveric Donor: Reimbursed at Cost Pass Through | Living Donor: 70% of Billed Charges | Reimbursed at 55% of Billed Charges | 70% of Billed Charges in Excess of the Threshold ($318,000) | Begins at Evaluation | Begins One (1) Day Prior to Admission and Ends at Discharge | Ends One (1) Year from Discharge | 34.037489 | -81.0077761 | |||||||||||||||
Medical University of South Carolina | Transplant | Columbia | SC | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $106,000 | N/A | N/A | Lesser of 95% | 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges in Excess of the Threshold ($159,000) | Begins at Evaluation | Begins on the Day of Mobilization Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 34.037489 | -81.0077761 | ||||||||||||||||
Medical University of South Carolina | Transplant | Columbia | SC | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $153,700 | N/A | N/A | Lesser of 95% | 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges in Excess of the Threshold ($230,550) | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 34.037489 | -81.0077761 | ||||||||||||||||
Medical University of South Carolina | Transplant | Columbia | SC | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $196,100 | N/A | N/A | Lesser of 95% | 75% of Billed Charges | Charges Reimbursed at Cost Pass Through | Reimbursed at Invoice Cost | 70% of Billed Charges in Excess of the Threshold ($294,150) | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 34.037489 | -81.0077761 | ||||||||||||||||
Avera McKennan Hospital | Transplant | Sioux Falls | SD | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $95,000 | 30 | $2,600 | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.5511761 | -96.7940512 | ||||||||||||||||
Avera McKennan Hospital | Transplant | Sioux Falls | SD | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | $133,000 | 35 | $2,600 | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.5511761 | -96.7940512 | ||||||||||||||||
Avera McKennan Hospital | Transplant | Sioux Falls | SD | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | $145,000 | 40 | $2,600 | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.5511761 | -96.7940512 | ||||||||||||||||
Avera McKennan Hospital | Transplant | Sioux Falls | SD | Kidney | Kidney | Adult | Member's Choice | $80,000 | 8 | $2,600 | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 43.5511761 | -96.7940512 | ||||||||||||||||
Avera McKennan Hospital | Transplant | Sioux Falls | SD | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $90,000 | 10 | $2,600 | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 43.5511761 | -96.7940512 | ||||||||||||||||
Avera McKennan Hospital | Transplant | Sioux Falls | SD | Liver | Liver | Adult | Member's Choice | $155,000 | 21 | $2,600 | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 43.5511761 | -96.7940512 | ||||||||||||||||
Avera McKennan Hospital | Transplant | Sioux Falls | SD | Pancreas | Pancreas | Adult | Member's Choice | $90,000 | 10 | $2,600 | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 43.5511761 | -96.7940512 | ||||||||||||||||
Methodist University Hospital | Transplant | Memphis | TN | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | Cadaveric Donor: $64,000 | Living Donor: $68,000 | 13 | $2,000 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends One (1) Year from Discharge | 35.129105 | -90.1112123 | |||||||||||||||
Methodist University Hospital | Transplant | Memphis | TN | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $101,000 | 17 | $2,000 Med/Surg:$2,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends One (1) Year from Discharge | 35.129105 | -90.1112123 | ||||||||||||||||
Methodist University Hospital | Transplant | Memphis | TN | Liver | Liver | Adult | Member's Choice | $149,900 | 22 | $2,000 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends One (1) Year from Discharge | 35.129105 | -90.1112123 | ||||||||||||||||
Methodist University Hospital | Transplant | Memphis | TN | Pancreas | Pancreas | Adult | Member's Choice | $87,000 | 15 | $2,000 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends One (1) Year from Discharge | 35.129105 | -90.1112123 | ||||||||||||||||
Methodist University Hospital | Transplant | Memphis | TN | Kidney | Kidney | Pediatric | Member's Choice | $69,000 | 15 | $2,000 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends One (1) Year from Discharge | 35.129105 | -90.1112123 | ||||||||||||||||
Methodist University Hospital | Transplant | Memphis | TN | Liver | Liver | Pediatric | Member's Choice | $155,000 | 24 | $2,000 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | Inpatient Hospital: $2,916 (Med/Surg), $3,240 (ICU/CCU) | All Other: 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired Ends One Year from the End of the Transplant Phase | Ends One (1) Year from Discharge | 35.129105 | -90.1112123 | ||||||||||||||||
St Jude Children's Research Hospital | Transplant | Memphis | TN | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $138,000 | 35 | $2,916 Med/Surg | $3,240 ICU/CCU | 90% of Billed Charges | Inpatient Hospital: $2,916 (Med/Surg), $3,240 (ICU/CCU) | All Other: 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 35.129105 | -90.1112123 | ||||||||||||||||
St Jude Children's Research Hospital | Transplant | Memphis | TN | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $192,000 | 35 | $2,916 Med/Surg | $3,240 ICU/CCU | 90% of Billed Charges | Inpatient Hospital: $2,916 (Med/Surg), $3,240 (ICU/CCU) | All Other: 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 35.129105 | -90.1112123 | ||||||||||||||||
St Jude Children's Research Hospital | Transplant | Memphis | TN | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $222,000 | 35 | $2,916 Med/Surg | $3,240 ICU/CCU | 90% of Billed Charges | Inpatient Hospital: $2,916 (Med/Surg), $3,240 (ICU/CCU) | All Other: 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 35.129105 | -90.1112123 | ||||||||||||||||
St Jude Children's Research Hospital | Transplant | Memphis | TN | Blood/Marrow (Tandem) | Tandem Auto to Allo | Pediatric | Programs of Excellence | 65% of Billed Charges | N/A | N/A | 90% of Billed Charges | Inpatient Hospital: $2,916 (Med/Surg), $3,240 (ICU/CCU) | All Other: 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 35.129105 | -90.1112123 | ||||||||||||||||
St Jude Children's Research Hospital | Transplant | Memphis | TN | Blood/Marrow (Tandem) | Tandem Auto to Auto | Pediatric | Programs of Excellence | 65% of Billed Charges | N/A | N/A | 90% of Billed Charges | Inpatient Hospital: $2,916 (Med/Surg), $3,240 (ICU/CCU) | All Other: 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 35.129105 | -90.1112123 | ||||||||||||||||
Vanderbilt University Medical Center | Transplant | Nashville | TN | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceELITE | Inpatient: $85,000 | Outpatient: $80,000 | Inpatient: 20 | Outpatient: 30 | Hospital: $3,800 | Professional: $200 | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 36.1865585 | -86.9256707 | |||||||||||||||
Vanderbilt University Medical Center | Transplant | Nashville | TN | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceELITE | Inpatient: $135,000 | Outpatient: $125,000 | Inpatient: 20 | Outpatient: 30 | Hospital: $3,800 | Professional: $200 | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 36.1865585 | -86.9256707 | |||||||||||||||
Vanderbilt University Medical Center | Transplant | Nashville | TN | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceELITE | Inpatient: $160,000 | Outpatient: $150,000 | Inpatient: 20 | Outpatient 30 | Hospital: $3,800 | Professional: $200 | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 36.1865585 | -86.9256707 | |||||||||||||||
Vanderbilt University Medical Center | Transplant | Nashville | TN | Heart | Heart | Adult | Programs of Excellence | PerformanceSELECT | $135,000 | 15 | Hospital: $3,700 | Professional: $300 | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at 54.6% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 36.1865585 | -86.9256707 | |||||||||||||||
Vanderbilt University Medical Center | Transplant | Nashville | TN | Heart/Lung | Heart/Lung | Adult | Member's Choice | $168,516 | 15 | Hospital: $3,700 | Professional: $301 | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at 54.6% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 36.1865585 | -86.9256707 | ||||||||||||||||
Vanderbilt University Medical Center | Transplant | Nashville | TN | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | $75,000 | 10 | Hospital: $3,700 | Professional: $300 | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 36.1865585 | -86.9256707 | |||||||||||||||
Vanderbilt University Medical Center | Transplant | Nashville | TN | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceSELECT | $130,000 | 15 | Hospital: $3,700 | Professional: $300 | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 36.1865585 | -86.9256707 | |||||||||||||||
Vanderbilt University Medical Center | Transplant | Nashville | TN | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | Living Donor: $165,000 | Cadaveric Donor: $150,000 | 15 | Hospital: $3,700 | Professional: $300 | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 36.1865585 | -86.9256707 | |||||||||||||||
Vanderbilt University Medical Center | Transplant | Nashville | TN | Lung | Lung | Adult | Programs of Excellence | PerformanceSELECT | Single Lung: $158,000 | Bilateral Lung: $180,000 | 15 | Hospital: $3,700 | Professional: $300 | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 36.1865585 | -86.9256707 | |||||||||||||||
Vanderbilt University Medical Center | Transplant | Nashville | TN | Pancreas | Pancreas | Adult | Member's Choice | $105,000 | 15 | Hospital: $3,700 | Professional: $300 | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 36.1865585 | -86.9256707 | ||||||||||||||||
Vanderbilt University Medical Center | Transplant | Nashville | TN | Blood/Marrow (Autologous) | Autologous | Pediatric | Member's Choice | $96,000 | 20 | Hospital: $3,800 | Professional: $200 | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 36.1865585 | -86.9256707 | ||||||||||||||||
Vanderbilt University Medical Center | Transplant | Nashville | TN | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Member's Choice | Inpatient: $150,000 | Outpatient: $145,000 | Inpatient: 20 | Outpatient: 30 | Hospital: $3,800 | Professional: $200 | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 36.1865585 | -86.9256707 | ||||||||||||||||
Vanderbilt University Medical Center | Transplant | Nashville | TN | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Member's Choice | $185,000 | 20 | Hospital: $3,800 | Professional: $200 | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 36.1865585 | -86.9256707 | ||||||||||||||||
Vanderbilt University Medical Center | Transplant | Nashville | TN | Heart | Heart | Pediatric | Programs of Excellence | (0 - 4 Years): $185,000 | (5 - 17 Years): $150,000 | 15 | Hospital: $3,700 | Professional: $300 | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at 54.6% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 36.1865585 | -86.9256707 | ||||||||||||||||
Vanderbilt University Medical Center | Transplant | Nashville | TN | Kidney | Kidney | Pediatric | Member's Choice | $85,000 | 10 | Hospital: $3,700 | Professional: $300 | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 36.1865585 | -86.9256707 | ||||||||||||||||
Baylor All Saints Medical Center | Transplant | Fort Worth | TX | Kidney | Kidney | Adult | Member's Choice | Living Donor Hospital: $34,500 | Living Donor Professional: $28,000 | Cadaveric Donor Hospital: $42,500 | Cadaveric Donor Professional: $16,000 | Living Donor: 5 | Cadaveric Donor: 7 | Hospital: $2,500 | Professional: $600 | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 32.8007346 | -97.4297445 | ||||||||||||||||
Baylor All Saints Medical Center | Transplant | Fort Worth | TX | Liver | Liver | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $109,500 | Professional: $46,500 | 15 | Hospital: $2,500 | Professional: $600 | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 32.8007346 | -97.4297445 | |||||||||||||||
Baylor University Medical Center | Transplant | Dallas | TX | Islet | Islet | Adult | Member's Choice | 75% of Billed Charges | N/A | N/A | N/A | 75% of Billed Charges | 75% of Billed Charges | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | |||||||||||||||||
Baylor University Medical Center | Transplant | Dallas | TX | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | Hospital: $51,500 | Professional: $23,460 | 12 | 80% of Billed Charges | Hospital: $2,500 | Professional: $600 | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | |||||||||||||||
Baylor University Medical Center | Transplant | Dallas | TX | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | Hospital: $97,500 | Professional: $29,325 | 18 | 80% of Billed Charges | Hospital: $2,500 | Professional: $600 | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | |||||||||||||||
Baylor University Medical Center | Transplant | Dallas | TX | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | Hospital: $119,500 | Professional: $34,500 | 20 | 80% of Billed Charges | Hospital: $2,500 | Professional: $600 | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 75% of Billed Charges | 70% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | |||||||||||||||
Baylor University Medical Center | Transplant | Dallas | TX | Heart | Heart | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $115,000 | Professional: $35,000 | 15 | Hospital: $2,500 | Professional: $600 | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at 75% of Billed Charges | 70% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | |||||||||||||||
Baylor University Medical Center | Transplant | Dallas | TX | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | Living Donor Hospital: $34,500 | Living Donor Professional: $28,000 | Cadaveric Donor Hospital: $42,500 | Cadaveric Donor Professional: $16,000 | Living Donor: 5 | Cadaveric Donor: 7 | Hospital: $2,500 | Professional: $600 | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | |||||||||||||||
Baylor University Medical Center | Transplant | Dallas | TX | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $67,500 | Professional: $23,000 | 7 | Hospital: $2,500 | Professional: $600 | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | |||||||||||||||
Baylor University Medical Center | Transplant | Dallas | TX | Liver | Liver | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $109,500 | Professional: $46,500 | 15 | Hospital: $2,500 | Professional: $600 | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | |||||||||||||||
Baylor University Medical Center | Transplant | Dallas | TX | Lung | Lung | Adult | Programs of Excellence | PerformanceELITE | Single Lung Hospital: $111,500 | Single Lung Professional: $31,500 | Bilateral Lung Hospital: $122,500 | Bilateral Lung Professional: $33,500 | Single Lung: 14 | Bilateral Lung: 18 | Hospital $2,500 | Professional $600 | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 70% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | |||||||||||||||
CHI St Luke's Health Baylor College of Medicine Medical Center | Transplant | Houston | TX | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $115,000 | Professional: 70% of Billed Charges | 20 | $2,900 ICU/CCU | $2,900 Med/Surg | 90% of Billed Charges | Hospital: 70% of Billed Charges | Professional: 70% of Billed Charges | Cardiovascular Care: 80% of Billed Charges | Included in Case Rate | (Revenue Codes: 275, 276, 278, 279) Reimbursed at 60% of Billed Charges | (Revenue Code: 624 - Category B) Reimbursed at 100% of Billed Charges | 60% of Billed Charges in Excess of the Threshold (166 Times the Case Rate Plus any Applicable Per Diems) | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | |||||||||||||||
CHI St Luke's Health Baylor College of Medicine Medical Center | Transplant | Houston | TX | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | Cadaveric Donor Hospital: $55,000 | Cadaveric Donor Professional: 70% of Billed Charges | Living Donor Hospital: $40,000 | Cadaveric Donor Professional: 70% of Billed Charges | Cadaveric Donor: 10 | Living Donor: 20 | $2,900 ICU/CCU | $2,500 Med/Surg | 90% of Billed Charges | Hospital: 70% of Billed Charges | Professional: 70% of Billed Charges | Cardiovascular Care: 80% of Billed Charges | Included in Case Rate | (Revenue Codes: 275, 276, 278, 279) Reimbursed at 60% of Billed Charges | (Revenue Code: 624 - Category B) Reimbursed at 100% of Billed Charges | 60% of Billed Charges in Excess of the Threshold (166 Times the Case Rate Plus any Applicable Per Diems) | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | |||||||||||||||
CHI St Luke's Health Baylor College of Medicine Medical Center | Transplant | Houston | TX | Liver | Liver | Adult | Member's Choice | Cadaveric Donor Hospital: $130,000 | Cadaveric Donor Professional: 70% of Billed Charges | Living Donor Hospital: $115,000 | Cadaveric Donor Professional: 70% of Billed Charges | 20 | $2,900 ICU/CCU | $2,500 Med/Surg | 90% of Billed Charges | Hospital: 70% of Billed Charges | Professional: 70% of Billed Charges | Cardiovascular Care: 80% of Billed Charges | Included in Case Rate | (Revenue Codes: 275, 276, 278, 279) Reimbursed at 60% of Billed Charges | (Revenue Code: 624 - Category B) Reimbursed at 100% of Billed Charges | 60% of Billed Charges in Excess of the Threshold (166 Times the Case Rate Plus any Applicable Per Diems) | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | ||||||||||||||||
CHI St Luke's Health Baylor College of Medicine Medical Center | Transplant | Houston | TX | Pancreas | Pancreas | Adult | Member's Choice | Hospital: $70,000 | Professional: 70% of Billed Charges | 15 | $3,150 ICU/CCU | $2,500 Med/Surg | 90% of Billed Charges | Hospital: 70% of Billed Charges | Professional: 70% of Billed Charges | Cardiovascular Care: 80% of Billed Charges | Included in Case Rate | (Revenue Codes: 275, 276, 278, 279) Reimbursed at 60% of Billed Charges | (Revenue Code: 624 - Category B) Reimbursed at 100% of Billed Charges | 60% of Billed Charges in Excess of the Threshold (166 Times the Case Rate Plus any Applicable Per Diems) | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | ||||||||||||||||
CHI St Luke's Health Baylor College of Medicine Medical Center | Transplant | Houston | TX | Lung | Lung | Adult | Programs of Excellence | PerformanceSELECT | Single Lung Hospital: $155,000 | Single Lung Professional: 70% of Billed Charges | Bilateral Lung Hospital: $185,000 | Bilateral Lung Professional: 70% of Billed Charges | 15 | $3,500 Med/Surg | $3,500 ICU/CCU | 90% of Billed Charges | Hospital: 70% of Billed Charges | Professional: 70% of Billed Charges | Cardiovascular Care: 80% of Billed Charges | Living Donor Reimbursed at 50% of Billed Charges | Cadaveric Organ Acquisition Included in the Case Rate | N/A | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | |||||||||||||||
Children's Medical Center of Dallas | Transplant | Dallas | TX | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | Hospital: $110,000 | Professional: 70% of Billed Charges | 35 | $2,500 Med/Surg | $4,800 ICU/CCU | 90% of Billed Charges | Hospital: 75% of Billed Charges | Professional: 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 71% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | ||||||||||||||||
Children's Medical Center of Dallas | Transplant | Dallas | TX | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | Hospital: $150,000 | Professional: 70% of Billed Charges | 45 | $2,500 Med/Surg | $4,800 ICU/CCU | 90% of Billed Charges | Hospital: 75% of Billed Charges | Professional: 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 71% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | ||||||||||||||||
Children's Medical Center of Dallas | Transplant | Dallas | TX | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | Hospital: $170,000 | Professional: 70% of Billed Charges | 50 | $2,500 Med/Surg | $4,800 ICU/CCU | 90% of Billed Charges | Hospital: 75% of Billed Charges | Professional: 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 71% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | ||||||||||||||||
Children's Medical Center of Dallas | Transplant | Dallas | TX | Heart | Heart | Pediatric | Programs of Excellence | Hospital: $160,000 | Professional: 70% of Billed Charges | 26 | $2,500 Med/Surg | $5,500 ICU/CCU | 90% of Billed Charges | Hospital: 75% of Billed Charges | Professional: 70% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | 71% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | ||||||||||||||||
Children's Medical Center of Dallas | Transplant | Dallas | TX | Intestine | Intestine | Pediatric | Member's Choice | Hospital: $275,000 | Professional: 70% of Billed Charges | 46 | $2,500 Med/Surg | $5,500 ICU/CCU | 90% of Billed Charges | Hospital: 75% of Billed Charges | Professional: 70% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | 71% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | ||||||||||||||||
Children's Medical Center of Dallas | Transplant | Dallas | TX | Kidney | Kidney | Pediatric | Programs of Excellence | Hospital: $65,000 | Professional: 70% of Billed Charges | 16 | $2,500 Med/Surg | $4,800 ICU/CCU | 90% of Billed Charges | Hospital: 75% of Billed Charges | Professional: 70% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | 71% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | ||||||||||||||||
Children's Medical Center of Dallas | Transplant | Dallas | TX | Liver | Liver | Pediatric | Programs of Excellence | Cadaveric Donor: Hospital: $130,875 | Professional: 70% of Billed Charges | Living Donor: Hospital: $97,500 | Professional: 70% of Billed Charges | 24 | $2,500 Med/Surg | $4,800 ICU/CCU | 90% of Billed Charges | Hospital: 75% of Billed Charges | Professional: 70% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | 71% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | ||||||||||||||||
Houston Methodist Hospital | Transplant | Houston | TX | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $80,000 | Professional: $20,000 | 20 | $750 Med/Surg | $1,000 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 55% of Hospital Billed Charges | 55% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | ||||||||||||||
Houston Methodist Hospital | Transplant | Houston | TX | Blood/Marrow (Allogeneic Unrelated) | Allogeneci Unrelated | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $125,000 | Professional: $40,000 | 30 | $750 Med/Surg | $1,000 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | 100% of Invoice Cost | 100% of Invoice Cost | 55% of Hospital Billed Charges | 55% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | ||||||||||||||
Houston Methodist Hospital | Transplant | Houston | TX | Blood/Marrow (Allogeneic Related) | Allogeneci Related | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $100,000 | Professional: $36,000 | 25 | $750 Med/Surg | $1,000 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | 100% of Invoice Cost | 55% of Hospital Billed Charges | 55% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | ||||||||||||||
Houston Methodist Hospital | Transplant | Houston | TX | Heart | Heart | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $110,000 | Professional: $36,500 | 20 | $750 Med/Surg | $1,000 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | 55% of Hospital Billed Charges | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | |||||||||||||||
Houston Methodist Hospital | Transplant | Houston | TX | Heart/Lung | Heart/Lung | Adult | Member's Choice | Hospital: 60% of Billed Charges | Professional: 70% of Billed Charges | N/A | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | 55% of Hospital Billed Charges | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | |||||||||||||||||
Houston Methodist Hospital | Transplant | Houston | TX | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $58,000 | Professional: $23,400 | 15 | $500 Med/Surg | $750 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | 55% of Hospital Billed Charges | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | |||||||||||||||
Houston Methodist Hospital | Transplant | Houston | TX | Kidney/Liver | Kidney/Liver | Adult | Member's Choice | Hospital: 60% of Billed Charges | Professional: 70% of Billed Charges | N/A | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | 55% of Hospital Billed Charges | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | |||||||||||||||||
Houston Methodist Hospital | Transplant | Houston | TX | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceELITE | Hospital: 60% of Billed Charges | Professional: 70% of Billed Charges | N/A | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | 55% of Hospital Billed Charges | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | ||||||||||||||||
Houston Methodist Hospital | Transplant | Houston | TX | Liver | Liver | Adult | Programs of Excellence | PerformanceSELECT | Hospital: $90,000 | Professional: $38,000 | 15 | $500 Med/Surg | $750 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | 55% of Hospital Billed Charges | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | |||||||||||||||
Houston Methodist Hospital | Transplant | Houston | TX | Lung | Lung | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $125,000 | Professional: $48,900 | 20 | $500 Med/Surg | $750 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | 55% of Hospital Billed Charges | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | |||||||||||||||
Houston Methodist Hospital | Transplant | Houston | TX | Pancreas | Pancreas | Adult | Member's Choice | Hospital: 60% of Billed Charges | Professional: 70% of Billed Charges | N/A | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | 55% of Hospital Billed Charges | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | |||||||||||||||||
MD Anderson Cancer Center | Transplant | Houston | TX | Blood/Marrow (Autologous, Breast Cancer) | Autologous | Adult | Programs of Excellence | PerformanceELITE | $84,360 | 30 | $3,500 Med/Surg | $4,000 ICU/CCU | 90% of Billed Charges | 85% of Billed Charges | Routine Harvest: $10,000 | Complex Harvest: $20,000 | Invoice Cost, Plus 10% | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | |||||||||||||||
MD Anderson Cancer Center | Transplant | Houston | TX | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceELITE | $96,900 | 30 | $3,500 Med/Surg | $4,000 ICU/CCU | 90% of Billed Charges | 85% of Billed Charges | Routine Harvest: $10,000 | Complex Harvest: $20,000 | Invoice Cost, Plus 10% | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | |||||||||||||||
MD Anderson Cancer Center | Transplant | Houston | TX | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceELITE | $133,380 | 40 | $3,500 Med/Surg | $4,000 ICU/CCU | 90% of Billed Charges | 85% of Billed Charges | Routine Harvest: $10,000 | Complex Harvest: $20,000 | Invoice Cost, Plus 10% | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | |||||||||||||||
MD Anderson Cancer Center | Transplant | Houston | TX | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceELITE | $186,960 | 40 | $3,500 Med/Surg | $4,000 ICU/CCU | 90% of Billed Charges | 85% of Billed Charges | 85% of Billed Charges | Invoice Cost, Plus 10% | 65% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | |||||||||||||||
Methodist Dallas Medical Center | Transplant | Dallas | TX | Kidney | Kidney | Adult | Programs of Excellence | PerformanceELITE | Cadaveric Donor: $96,775 | Living Donor: $89,138 | 10 | $4,207 Med/Surg | $5,073 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | |||||||||||||||
Methodist Dallas Medical Center | Transplant | Dallas | TX | Kidney/Liver | Kidney/Liver | Adult | Member's Choice | $271,711 | 16 | $4,643 Med/Surg | $5,073 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | ||||||||||||||||
Methodist Dallas Medical Center | Transplant | Dallas | TX | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $159,661 | 12 | $4,207 Med/Surg | $5,073 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | ||||||||||||||||
Methodist Dallas Medical Center | Transplant | Dallas | TX | Liver | Liver | Adult | Member's Choice | $218,500 | 15 | $4,207 Med/Surg | $5,073 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | ||||||||||||||||
Scott and White Memorial Hospital | Transplant | Temple | TX | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $127,000 | N/A | N/A | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | N/A | If Billed Charges Exceed $254,000, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins on the First Day of Ablative Therapy and Ends on the Day of Discharge | Ends One (1) Year from Discharge | 31.1039597 | -97.4220357 | ||||||||||||||||
Scott and White Memorial Hospital | Transplant | Temple | TX | Heart | Heart | Adult | Member's Choice | $130,000 | N/A | N/A | 90% of Billed Charges | 70% of Billed Charges | Included in the Case Rate | Reimbursed at 65% of Billed Charges | If Billed Charges Exceed $260,000, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 31.1039597 | -97.4220357 | ||||||||||||||||
Scott and White Memorial Hospital | Transplant | Temple | TX | Kidney | Kidney | Adult | Programs of Excellence | PerformanceSELECT | $99,000 | N/A | N/A | 90% of Billed Charges | 70% of Billed Charges | Included in the Case Rate | Reimbursed at 65% of Billed Charges | If Billed Charges Exceed $198,000, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 31.1039597 | -97.4220357 | |||||||||||||||
Scott and White Memorial Hospital | Transplant | Temple | TX | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $142,000 | N/A | N/A | 90% of Billed Charges | 70% of Billed Charges | Included in the Case Rate | Reimbursed at 65% of Billed Charges | If Billed Charges Exceed $284,000, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 31.1039597 | -97.4220357 | ||||||||||||||||
Scott and White Memorial Hospital | Transplant | Temple | TX | Pancreas | Pancreas | Adult | Member's Choice | $113,000 | N/A | N/A | 90% of Billed Charges | 70% of Billed Charges | Included in the Case Rate | Reimbursed at 65% of Billed Charges | If Billed Charges Exceed $226,000, Payment will be the Transplant Case Rate, Plus 65% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 31.1039597 | -97.4220357 | ||||||||||||||||
Texas Children's Hospital | Transplant | Houston | TX | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | Hospital: $85,000 | Physicians: 70% of Billed Charges | 30 | $1,800 Med/Surg | $2,400 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins on the First Day of Ablative Therapy and Ends when the Inlier Days have Expired | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | ||||||||||||||||
Texas Children's Hospital | Transplant | Houston | TX | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | Hospital: $105,000 | Physicians: 70% of Billed Charges | 35 | $1,800 Med/Surg | $2,400 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins on the First Day of Ablative Therapy and Ends when the Inlier Days have Expired | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | ||||||||||||||||
Texas Children's Hospital | Transplant | Houston | TX | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | Hospital: $120,000 | Physicians: 70% of Billed Charges | 40 | $1,800 Med/Surg | $2,400 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Begins on the First Day of Ablative Therapy and Ends when the Inlier Days have Expired | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | ||||||||||||||||
Texas Children's Hospital | Transplant | Houston | TX | Heart | Heart | Pediatric | Programs of Excellence | $130,000 | 30 | $1,800 Med/Surg | $2,400 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost Plus 10% | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends When the Inlier Days Have Expired | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | ||||||||||||||||
Texas Children's Hospital | Transplant | Houston | TX | Kidney | Kidney | Pediatric | Programs of Excellence | Deceased Donor Hospital: $56,000 | Deceased Donor Physicians: 70% of Billed Charges | Living Donor Hospital: $60,000 | Living Donor Physicians: 70% of Billed Charges | 15 | $1,800 Med/Surg | $2,400 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost Plus 10% | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends When the Inlier Days Have Expired | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | ||||||||||||||||
Texas Children's Hospital | Transplant | Houston | TX | Liver | Liver | Pediatric | Programs of Excellence | Hosptial: $100,000 | Physicians: 70% of Billed Charges | 22 | $1,800 Med/Surg | $2,400 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost Plus 10% | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends When the Inlier Days Have Expired | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | ||||||||||||||||
Texas Children's Hospital | Transplant | Houston | TX | Lung | Lung | Pediatric | Programs of Excellence | Single Lung Hospital: $110,000 | Single Lung Physicians: 70% of Billed Charges | Double Lung Hospital: $150,000 | Double Lung Physicians: 70% of Billed Charges | 30 | $1,800 Med/Surg | $2,400 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost Plus 10% | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends When the Inlier Days Have Expired | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | ||||||||||||||||
Texas Transplant Institute | Transplant | San Antonio | TX | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceSELECT | $85,000 | 25 | $2,000 Med/Surg | $2,500 ICU/CCU | 75% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 55% of Billed Charges | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends When the IInlier Days Have Expired | Ends 90 Days from Discharge | 29.4813568 | -98.6548302 | |||||||||||||||
Texas Transplant Institute | Transplant | San Antonio | TX | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceSELECT | $110,000 | 40 | $2,500 Med/Surg | $3,000 ICU/CCU | 75% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 55% of Billed Charges | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends When the IInlier Days Have Expired | Ends 90 Days from Discharge | 29.4813568 | -98.6548302 | |||||||||||||||
Texas Transplant Institute | Transplant | San Antonio | TX | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceSELECT | $170,000 | 40 | $2,500 Med/Surg | $3,000 ICU/CCU | 75% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 55% of Billed Charges | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends When the IInlier Days Have Expired | Ends 90 Days from Discharge | 29.4813568 | -98.6548302 | |||||||||||||||
Texas Transplant Institute | Transplant | San Antonio | TX | Heart | Heart | Adult | Programs of Excellence | PerformanceSELECT | $130,000 | 15 | $1,500 Med/Surg | $2,500 ICU/CCU | 75% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ending the Day of Discharge | Ends 90 Days from Discharge | 29.4813568 | -98.6548302 | |||||||||||||||
Texas Transplant Institute | Transplant | San Antonio | TX | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | Cadaveric Donor: $62,000 | Living Donor: $52,000 | 12 | $2,000 Med/Surg | $2,000 ICU/CCU | 75% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant | Ends 90 Days from Discharge | 29.4813568 | -98.6548302 | |||||||||||||||
Texas Transplant Institute | Transplant | San Antonio | TX | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $87,000 | 12 | $2,000 Med/Surg | $2,000 ICU/CCU | 75% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ending the Day of Discharge | Ends 90 Days from Discharge | 29.4813568 | -98.6548302 | ||||||||||||||||
Texas Transplant Institute | Transplant | San Antonio | TX | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | $120,000 | 15 | $1,500 Med/Surg | $2,500 ICU/CCU | 75% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ending the Day of Discharge | Ends 90 Days from Discharge | 29.4813568 | -98.6548302 | |||||||||||||||
Texas Transplant Institute | Transplant | San Antonio | TX | Pancreas | Pancreas | Adult | Member's Choice | $72,000 | 12 | $2,000 Med/Surg | $2,000 ICU/CCU | 75% of Billed Charges | 75% of Billed Charges | Procurement in Local Organ Bank Service Area is Included in Case Rate | Procurement Outside of Service Area is Invoice Cost | N/A | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 90 Days from Discharge | 29.4813568 | -98.6548302 | ||||||||||||||||
Texas Transplant Institute | Transplant | San Antonio | TX | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $90,000 | 25 | $2,000 Med/Surg | $2,000 ICU/CCU | 75% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 55% of Billed Charges | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends When the Inlier Days Have Expired | Ends 90 Days from Discharge | 29.4813568 | -98.6548302 | ||||||||||||||||
Texas Transplant Institute | Transplant | San Antonio | TX | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $115,000 | 40 | $2,500 Med/Surg | $3,000 ICU/CCU | 75% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 55% of Billed Charges | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends When the Inlier Days Have Expired | Ends 90 Days from Discharge | 29.4813568 | -98.6548302 | ||||||||||||||||
Texas Transplant Institute | Transplant | San Antonio | TX | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $175,000 | 40 | $2,500 Med/Surg | $3,000 ICU/CCU | 75% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 55% of Billed Charges | Begins at Evaluation | Begins on the Day of Preparative Therapy and Ends When the Inlier Days Have Expired | Ends 90 Days from Discharge | 29.4813568 | -98.6548302 | ||||||||||||||||
University Hospital - University Health System | Transplant | San Antonio | TX | Kidney | Kidney | Adult | Member's Choice | Cadaveric Donor | Hospital: $79,500 | Physician: $21,520 | Living Donor | Hospital: $70,500 | Physician: $26,303 | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | Reimbursed at Invoice Cost | N/A | 2.5 Times the Case Rate & 70% of Billed Charges Thereafter | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.4813568 | -98.6548302 | ||||||||||||||||
University Hospital - University Health System | Transplant | San Antonio | TX | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | Cadaveric Donor | Hospital: $153,500 | Physician: $60,973 | Living Donor | Hospital: $144,000 | Physician: $65,158 | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | Reimbursed at Invoice Cost | N/A | 2.5 Times the Case Rate & 70% of Billed Charges Thereafter | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.4813568 | -98.6548302 | |||||||||||||||
University Hospital - University Health System | Transplant | San Antonio | TX | Lung | Lung | Adult | Programs of Excellence | PerformanceELITE | Single Lung |Hospital: $181,750 | Physician: $45,431 | Bilateral Lung | Hospital: $227,000 | Physician: $50,214 | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | Reimbursed at Invoice Cost | N/A | 2.5 Times the Case Rate & 70% of Billed Charges Thereafter | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.4813568 | -98.6548302 | |||||||||||||||
University Hospital - University Health System | Transplant | San Antonio | TX | Kidney | Kidney | Pediatric | Member's Choice | Cadaveric Donor | Hospital: $76,500 | Physician: $22,716 | Living Donor | Hospital: $68,000 | Physician: $28,694 | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | Reimbursed at Invoice Cost | N/A | 2.5 Times the Case Rate & 70% of Billed Charges Thereafter | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.4813568 | -98.6548302 | ||||||||||||||||
University Hospital - University Health System | Transplant | San Antonio | TX | Liver | Liver | Pediatric | Member's Choice | Cadaveric Donor | Hospital: $153,500 | Physician: $60,973 | Living Donor | Hospital: $144,000 | Physician: $65,158 | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | Reimbursed at Invoice Cost | N/A | 2.5 Times the Case Rate & 70% of Billed Charges Thereafter | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.4813568 | -98.6548302 | ||||||||||||||||
University Hospital - University Health System | Transplant | San Antonio | TX | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | Hospital: $107,750 | Physician: $31,084 | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | Reimbursed at Invoice Cost | N/A | 2.5 Times the Case Rate & 70% of Billed Charges Thereafter | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 29.4813568 | -98.6548302 | ||||||||||||||||
UT Southwestern Medical Center | Transplant | Dallas | TX | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $77,000 | 25 | $2,300 Med/Surg | $2,900 ICU/CCU | 80% of Billed Charges | 80% of Billed Charges | Included in Case Rate | N/A | 50% of Billed Charges | Begins at Evaluation | Begins on the First Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | ||||||||||||||||
UT Southwestern Medical Center | Transplant | Dallas | TX | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | $119,000 | 30 | $2,300 Med/Surg | $2,900 ICU/CCU | 80% of Billed Charges | 80% of Billed Charges | Included in Case Rate | N/A | 50% of Billed Charges | Begins at Evaluation | Begins on the First Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | ||||||||||||||||
UT Southwestern Medical Center | Transplant | Dallas | TX | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | $155,000 | 35 | $2,300 Med/Surg | $2,900 ICU/CCU | 80% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins on the First Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | ||||||||||||||||
UT Southwestern Medical Center | Transplant | Dallas | TX | Heart | Heart | Adult | Programs of Excellence | PerformanceSELECT | $110,000 | 25 | $2,300 Med/Surg | $2,900 ICU/CCU | 80% of Billed Charges | 80% of Billed Charges | Reimbursed at Standard Acquisition Charge not to Exceed OPO Invoice Cost, Plus 45% | Reimbursed at Invoice Cost | 2 Times the Case Rate, Plus any Applicable Per Diems | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | |||||||||||||||
UT Southwestern Medical Center | Transplant | Dallas | TX | Kidney | Kidney | Adult | Member's Choice | $55,000 | 14 | $2,300 Med/Surg | $2,900 ICU/CCU | 80% of Billed Charges | 80% of Billed Charges | Reimbursed at Standard Acquisition Charge not to Exceed OPO Invoice Cost, Plus 45% | Reimbursed at Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | ||||||||||||||||
UT Southwestern Medical Center | Transplant | Dallas | TX | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $85,000 | 20 | $2,300 Med/Surg | $2,900 ICU/CCU | 80% of Billed Charges | 80% of Billed Charges | Reimbursed at Standard Acquisition Charge not to Exceed OPO Invoice Cost, Plus 45% | Reimbursed at Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | ||||||||||||||||
UT Southwestern Medical Center | Transplant | Dallas | TX | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | $125,000 | 15 | $2,300 Med/Surg | $2,900 ICU/CCU | 80% of Billed Charges | 80% of Billed Charges | Reimbursed at Standard Acquisition Charge not to Exceed OPO Invoice Cost, Plus 45% | Reimbursed at Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | |||||||||||||||
UT Southwestern Medical Center | Transplant | Dallas | TX | Heart & Lung | Heart/Lung | Adult | Member's Choice | $175,000 | 35 | $2,300 Med/Surg | $2,900 ICU/CCU | 80% of Billed Charges | 80% of Billed Charges | Reimbursed at Standard Acquisition Charge not to Exceed OPO Invoice Cost, Plus 45% | Reimbursed at Invoice Cost | 2 Times the Case Rate, Plus any Applicable Per Diems | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | ||||||||||||||||
UT Southwestern Medical Center | Transplant | Dallas | TX | Cord Blood | Cord Blood | Adult | Member's Choice | 75% of Billed Charges | N/A | N/A | N/A | 80% of Billed Charges | Included in Case Rate | Included in Case Rate | N/A | Begins at Evaluation | Begins on the First Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | ||||||||||||||||
UT Southwestern Medical Center | Transplant | Dallas | TX | Lung | Lung | Adult | Programs of Excellence | PerformanceSELECT | $140,000 | 35 | $2,300 Med/Surg | $2,900 ICU/CCU | 80% of Billed Charges | 80% of Billed Charges | Reimbursed at Standard Acquisition Charge not to Exceed OPO Invoice Cost, Plus 45% | Reimbursed at Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | |||||||||||||||
UT Southwestern Medical Center | Transplant | Dallas | TX | Pancreas | Pancreas | Adult | Member's Choice | $75,000 | 15 | $2,300 Med/Surg | $2,900 ICU/CCU | 80% of Billed Charges | 80% of Billed Charges | Reimbursed at Standard Acquisition Charge not to Exceed OPO Invoice Cost, Plus 45% | Reimbursed at Invoice Cost | 50% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 32.8205862 | -96.871968 | ||||||||||||||||
University of Utah Medical Center | Transplant | Salt Lake City | UT | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceQUALITY | $116,066 | 40 | $2,386 | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | For Outlier Days only, Never Less than 45% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 40.7765867 | -111.990696 | |||||||||||||||
University of Utah Medical Center | Transplant | Salt Lake City | UT | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | $160,539 | 40 | $2,386 | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | N/A | For Outlier Days only, Never Less than 45% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 40.7765867 | -111.990696 | |||||||||||||||
University of Utah Medical Center | Transplant | Salt Lake City | UT | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceQUALITY | $178,979 | 40 | $2,386 | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | For Outlier Days only, Never Less than 45% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 40.7765867 | -111.990696 | |||||||||||||||
University of Utah Medical Center | Transplant | Salt Lake City | UT | Heart | Heart | Adult | Programs of Excellence | PerformanceELITE | $113,896 | 25 | $2,386 | 90% of Billed Charges | 80% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | For Outlier Days only, Never Less than 45% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 40.7765867 | -111.990696 | |||||||||||||||
University of Utah Medical Center | Transplant | Salt Lake City | UT | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceSELECT | $99,503 | 16 | $2,386 | 90% of Billed Charges | 80% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | For Outlier Days only, Never Less than 45% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 40.7765867 | -111.990696 | |||||||||||||||
University of Utah Medical Center | Transplant | Salt Lake City | UT | Kidney | Kidney | Adult | Programs of Excellence | PerformanceELITE | Cadaveric Donor: $48,813 | Living Donor: $67,795 | 16 | $2,386 | 90% of Billed Charges | 80% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | For Outlier Days only, Never Less than 45% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 40.7765867 | -111.990696 | |||||||||||||||
University of Utah Medical Center | Transplant | Salt Lake City | UT | Liver | Liver | Adult | Programs of Excellence | PerformanceELITE | Cadaveric Donor: $135,5900 | Living Donor: $158,536 | 20 | $2,386 | 90% of Billed Charges | 80% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | For Outlier Days only, Never Less than 45% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 40.7765867 | -111.990696 | |||||||||||||||
University of Utah Medical Center | Transplant | Salt Lake City | UT | Lung | Lung | Adult | Member's Choice | Single or Bilateral: $135,590 | 24 | $2,386 | 90% of Billed Charges | 80% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | For Outlier Days only, Never Less than 45% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 40.7765867 | -111.990696 | ||||||||||||||||
University of Utah Medical Center | Transplant | Salt Lake City | UT | Pancreas | Pancreas | Adult | Member's Choice | $75,096 | 16 | $2,386 | 90% of Billed Charges | 80% of Billed Charges | Reimbursed at Invoice Cost | Reimbursed at Invoice Cost | For Outlier Days only, Never Less than 45% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 40.7765867 | -111.990696 | ||||||||||||||||
Seattle Cancer Care Alliance | Transplant | Seattle | WA | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceELITE | $239,799 | 25 | N/A | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at 80% of Billed Charges | 70% of Billed Charges | First Day of Outpatient Work-up | Begins on the Day of Ablative Therapy and Ends when Inlier Days have Expired | Ends One (1) Year After the Inlier Days have Elapsed | 47.613007 | -122.4122753 | |||||||||||||||
Seattle Cancer Care Alliance | Transplant | Seattle | WA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceELITE | Matched: $362,660 | Mismatched: $417,429 | 40 | N/A | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at 80% of Billed Charges | 70% of Billed Charges | First Day of Outpatient Work-up | Begins on the Day of Ablative Therapy and Ends when Inlier Days have Expired | Ends One (1) Year After the Inlier Days have Elapsed | 47.613007 | -122.4122753 | |||||||||||||||
Seattle Cancer Care Alliance | Transplant | Seattle | WA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceELITE | $507,724 | 40 | N/A | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at 80% of Billed Charges | 70% of Billed Charges | First Day of Outpatient Work-up | Begins on the Day of Ablative Therapy and Ends when Inlier Days have Expired | Ends One (1) Year After the Inlier Days have Elapsed | 47.613007 | -122.4122753 | |||||||||||||||
Seattle Cancer Care Alliance | Transplant | Seattle | WA | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $266,445 | 25 | N/A | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at 80% of Billed Charges | 75% of Billed Charges | First Day of Outpatient Work-up | Begins on the Day of Ablative Therapy and Ends when Inlier Days have Expired | Ends One (1) Year After the Inlier Days have Elapsed | 47.613007 | -122.4122753 | ||||||||||||||||
Seattle Cancer Care Alliance | Transplant | Seattle | WA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | Matched: $408,546 | Mismatched: $457,429 | 40 | N/A | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at 80% of Billed Charges | 75% of Billed Charges | First Day of Outpatient Work-up | Begins on the Day of Ablative Therapy and Ends when Inlier Days have Expired | Ends One (1) Year After the Inlier Days have Elapsed | 47.613007 | -122.4122753 | ||||||||||||||||
Seattle Cancer Care Alliance | Transplant | Seattle | WA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $558,053 | 40 | N/A | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at 80% of Billed Charges | 75% of Billed Charges | First Day of Outpatient Work-up | Begins on the Day of Ablative Therapy and Ends when Inlier Days have Expired | Ends One (1) Year After the Inlier Days have Elapsed | 47.613007 | -122.4122753 | ||||||||||||||||
Seattle Cancer Care Alliance | Transplant | Seattle | WA | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Adult | Programs of Excellence | PerformanceELITE | 80% of Billed Charges | N/A | N/A | N/A | 80% of Billed Charges | Included in Case Rate | Reimbursed at 80% of Billed Charges | N/A | First Day of Outpatient Work-up | Begins on the Day of Ablative Therapy and ends when Patients is Discharged | Ends One (1) Year After Discharge | 47.613007 | -122.4122753 | |||||||||||||||
Seattle Cancer Care Alliance | Transplant | Seattle | WA | Blood/Marrow (Tandem Auto to Allo) | Tandem Auto to Allo | Adult | Programs of Excellence | PerformanceELITE | 80% of Billed Charges | N/A | N/A | N/A | 80% of Billed Charges | Included in Case Rate | Reimbursed at 80% of Billed Charges | N/A | First Day of Outpatient Work-up | Begins on the Day of Ablative Therapy and ends when Patients is Discharged | Ends One (1) Year After Discharge | 47.613007 | -122.4122753 | |||||||||||||||
Seattle Cancer Care Alliance | Transplant | Seattle | WA | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Pediatric | Programs of Excellence | 80% of Billed Charges | N/A | N/A | N/A | 80% of Billed Charges | Included in Case Rate | Reimbursed at 80% of Billed Charges | N/A | First Day of Outpatient Work-up | Begins on the Day of Ablative Therapy and ends when Patients is Discharged | Ends One (1) Year After Discharge | 47.613007 | -122.4122753 | ||||||||||||||||
Seattle Cancer Care Alliance | Transplant | Seattle | WA | Blood/Marrow (Tandem Auto to Allo) | Tandem Auto to Allo | Pediatric | Programs of Excellence | 80% of Billed Charges | N/A | N/A | N/A | 80% of Billed Charges | Included in Case Rate | Reimbursed at 80% of Billed Charges | N/A | First Day of Outpatient Work-up | Begins on the Day of Ablative Therapy and ends when Patients is Discharged | Ends One (1) Year After Discharge | 47.613007 | -122.4122753 | ||||||||||||||||
Seattle Cancer Care Alliance | Transplant | Seattle | WA | Blood/Marrow (Cord Blood) | Cord Blood | Adult | Programs of Excellence | PerformanceELITE | $467,251 | 40 | N/A | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at 80% of Billed Charges | 70% of Billed Charges | First Day of Outpatient Work-up | Begins on the Day of Ablative Therapy and Ends when Inlier Days have Expired | Ends One (1) Year After the Inlier Days have Elapsed | 47.613007 | -122.4122753 | |||||||||||||||
Seattle Cancer Care Alliance | Transplant | Seattle | WA | Blood/Marrow (Cord Blood) | Cord Blood | Pediatric | Programs of Excellence | $518,519 | 40 | N/A | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at 80% of Billed Charges | 75% of Billed Charges | First Day of Outpatient Work-up | Begins on the Day of Ablative Therapy and Ends when Inlier Days have Expired | Ends One (1) Year After the Inlier Days have Elapsed | 47.613007 | -122.4122753 | ||||||||||||||||
Seattle Children's Hospital | Transplant | Seattle | WA | Heart | Heart | Pediatric | Programs of Excellence | Hospital: $216,979 | Professional: $53,871 | N/A | N/A | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at 85% of Billed Charges | 75% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 90 Days from Discharge | 47.613007 | -122.4122753 | ||||||||||||||||
Seattle Children's Hospital | Transplant | Seattle | WA | Intestine | Intestine | Pediatric | Member's Choice | 80% of Billed Charges | N/A | N/A | NA | 80% of Billed Charges | Included in Case Rate | Reimbursed at 85% of Billed Charges | NA | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 90 Days from Discharge | 47.613007 | -122.4122753 | ||||||||||||||||
Seattle Children's Hospital | Transplant | Seattle | WA | Intestine/Liver | Intestine/Liver | Pediatric | Member's Choice | 80% of Billed Charges | N/A | N/A | NA | 80% of Billed Charges | Included in Case Rate | Reimbursed at 85% of Billed Charges | NA | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 90 Days from Discharge | 47.613007 | -122.4122753 | ||||||||||||||||
Seattle Children's Hospital | Transplant | Seattle | WA | Kidney | Kidney | Pediatric | Programs of Excellence | Cadaveric Donor: Hospital: $91,296 | Professional: $22,929 | Living Donor: Hospital: $92,639 | Professional: $23,064 | N/A | N/A | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at 85% of Billed Charges | 75% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 90 Days from Discharge | 47.613007 | -122.4122753 | ||||||||||||||||
Seattle Children's Hospital | Transplant | Seattle | WA | Liver | Liver | Pediatric | Programs of Excellence | Cadaveric Donor Hospital: $211,246 | Cadaveric Donor Professional: $51,102 | Living Donor Hospital: $211,246 | Living Donor Professional: $52,090 | N/A | N/A | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at 85% of Billed Charges | 75% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 90 Days from Discharge | 47.613007 | -122.4122753 | ||||||||||||||||
Swedish Medical Center | Transplant | Seattle | WA | Kidney | Kidney | Adult | Member's Choice | Cadaveric Donor Hospital: $80,000 | Cadaveric Donor Professional: $10,000 | Living Donor Hospital: $78,000 | Living Donor Professional: $10,000 | N/A | N/A | 80% of Billed Charges | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | N/A | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 47.613007 | -122.4122753 | ||||||||||||||||
Swedish Medical Center | Transplant | Seattle | WA | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | Hospital: $158,000 | Professional: $16,000 | N/A | N/A | 80% of Billed Charges | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | N/A | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 47.613007 | -122.4122753 | ||||||||||||||||
Swedish Medical Center | Transplant | Seattle | WA | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $140,000 | Professional: $16,000 | N/A | N/A | 80% of Billed Charges | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | N/A | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 47.613007 | -122.4122753 | |||||||||||||||
Swedish Medical Center | Transplant | Seattle | WA | Pancreas | Pancreas | Adult | Member's Choice | Hospital: $78,332 | Professional: $8,900 | N/A | N/A | 80% of Billed Charges | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | N/A | 55% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 47.613007 | -122.4122753 | ||||||||||||||||
University of Washington Medical Center | Transplant | Seattle | WA | Heart | Heart | Adult | Programs of Excellence | PerformanceELITE | Hospital: $175,000 | Professional: 75% of Billed Charges | N/A | N/A | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | During Transplant Phase: Charges Included in Case Rate| Outside Transplant Phase: Charges Reimbursed at 75% of Billed Charges | Hospital: $300,000 & 76% of Billed Charges Thereafter | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 47.613007 | -122.4122753 | |||||||||||||||
University of Washington Medical Center | Transplant | Seattle | WA | Kidney | Kidney | Adult | Programs of Excellence | PerformanceELITE | Hospital: $95,000 | Professional: 75% of Billed Charges | N/A | N/A | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | Hospital: $150,000 & 76% of Billed Charges Thereafter | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 47.613007 | -122.4122753 | |||||||||||||||
University of Washington Medical Center | Transplant | Seattle | WA | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $150,000 | Professional: 75% of Billed Charges | N/A | N/A | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | Hospital: $255,000 & 76% of Billed Charges Thereafter | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 47.613007 | -122.4122753 | |||||||||||||||
University of Washington Medical Center | Transplant | Seattle | WA | Liver | Liver | Adult | Programs of Excellence | PerformanceELITE | Hospital: $155,000 | Professional: 75% of Billed Charges | N/A | N/A | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | Hospital: $258,000 & 76% of Billed Charges Thereafter | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 47.613007 | -122.4122753 | |||||||||||||||
University of Washington Medical Center | Transplant | Seattle | WA | Lung | Lung | Adult | Programs of Excellence | PerformanceQUALITY | Single Lung Hospital: $170,000 | Single Lung Professional: 75% of Billed Charges | Bilateral Lung Hospital: $175,000 | Bilateral Lung Professional: 75% of Billed Charges | N/A | N/A | 80% of Billed Charges | 75% of Billed Charges | Included in Case Rate | N/A | Single Lung | Hospital: $275,000 & 76% of Billed Charges Thereafter | Bilateral Lung | $290,000 & 76% of Billed Charges Thereafter | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 47.613007 | -122.4122753 | |||||||||||||||
University of Washington Medical Center | Transplant | Seattle | WA | Multi-Visceral | Multi-Visceral | Adult | Member's Choice | Hospital: 72% of Billed Charges | Professional: 75% of Billed Charges | N/A | N/A | N/A | 75% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends One (1) Year from Discharge | 47.613007 | -122.4122753 | ||||||||||||||||
Sacred Heart Medical Center | Transplant | Spokane | WA | Kidney | Kidney | Adult | Member's Choice | $104,000 | N/A | N/A | 80% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | If Charges Exceed $190,000, Payment will be the Case Rate, Plus 50% of the Excess Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 365 Days from Discharge | 47.6729347 | -117.4821894 | ||||||||||||||||
Aurora St Luke's Medical Center | Transplant | Milwaukee | WI | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $120,000 | 12 | $4,000 Med/Surg | $5,000 ICU/CCU | 75% of Billed Charges | 65% of Billed Charges | Included in Case Rate | Included in Case Rate | $240,000 | 65% of Billed Charges Beyond Threshold Amount | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends 180 Days from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||
Aurora St Luke's Medical Center | Transplant | Milwaukee | WI | Heart | Heart | Adult | Member's Choice | $235,000 | 18 | $4,000 Med/Surg | $5,000 ICU/CCU | N/A | 65% of Billed Charges | Included in Case Rate | Reimbursed at 50% of Hospitals Billed Charges | $470,000 | 65% of Billed Charges Beyond Threshold Amount | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 180 Days from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||
Aurora St Luke's Medical Center | Transplant | Milwaukee | WI | Kidney | Kidney | Adult | Member's Choice | Cadaveric Donor: $95,000 | Living Donor: $99,000 | 12 | $4,000 Med/Surg | $5,000 ICU/CCU | 75% of Billed Charges | 65% of Billed Charges | Included in Case Rate | Reimbursed at 50% of Hospitals Billed Charges | Cadaveric Donor: $190,000 | Living Donor: $198,000 | 65% of Billed Charges Beyond the Threshold Amounts | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 180 Days from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||
Aurora St Luke's Medical Center | Transplant | Milwaukee | WI | Liver | Liver | Adult | Member's Choice | Cadaveric Donor: $220,000 | Living Donor: $230,000 | 17 | $4,000 Med/Surg | $5,000 ICU/CCU | 75% of Billed Charges | 65% of Billed Charges | Included in Case Rate | Reimbursed at 50% of Hospitals Billed Charges | Cadaveric Donor: $440,000 | Living Donor: $460,000 | 65% of Billed Charges Beyond the Threshold Amounts | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 180 Days from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||
Aurora St Luke's Medical Center | Transplant | Milwaukee | WI | Dual Organ | Multi-Organ | Adult | Member's Choice | 100% of Higher Cost Organ, Plus 50% of Lower Cost Organ | Equal to Number of Days of more Expensive Organ | $4,000 Med/Surg | $5,000 ICU/CCU | 75% of Billed Charges | 65% of Billed Charges | Included in Case Rate | Reimbursed at 50% of Hospitals Billed Charges | 100% of Higher Cost Organ Threshold, Plus 50% of Lower Cost Organ Threshold | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 180 Days from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||
Children's Hospital of Wisconsin | Transplant | Milwaukee | WI | Blood/Marrow (Cord Blood) | Cord Blood | Pediatric | Programs of Excellence | $198,000 | 35 | $3,600 Med/Surg | $3,600 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||
Children's Hospital of Wisconsin | Transplant | Milwaukee | WI | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $150,000 | 30 | $3,600 Med/Surg | $3,600 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||
Children's Hospital of Wisconsin | Transplant | Milwaukee | WI | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $198,000 | 35 | $3,600 Med/Surg | $3,600 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||
Children's Hospital of Wisconsin | Transplant | Milwaukee | WI | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $204,000 | 40 | $3,600 Med/Surg | $3,600 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||
Children's Hospital of Wisconsin | Transplant | Milwaukee | WI | Lung | Lung | Pediatric | Programs of Excellence | $192,000 | 30 | $4,200 Med/Surg | $4,200 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||
Children's Hospital of Wisconsin | Transplant | Milwaukee | WI | Heart & Lung | Heart/Lung | Pediatric | Programs of Excellence | $198,000 | 35 | $4,200 Med/Surg | $4,200 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||
Children's Hospital of Wisconsin | Transplant | Milwaukee | WI | Heart | Heart | Pediatric | Programs of Excellence | $186,000 | 25 | $4,200 Med/Surg | $4,200 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||
Children's Hospital of Wisconsin | Transplant | Milwaukee | WI | Kidney | Kidney | Pediatric | Member's Choice | $84,000 | 12 | $4,200 Med/Surg | $4,200 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||
Children's Hospital of Wisconsin | Transplant | Milwaukee | WI | Liver | Liver | Pediatric | Member's Choice | $186,000 | 30 | $4,200 Med/Surg | $4,200 ICU/CCU | 90% of Billed Charges | 75% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||
Froedtert Memorial Lutheran Hospital | Transplant | Milwaukee | WI | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceELITE | $85,000 | 25 | $1,900 Med/Surg | $2,800 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.0578056 | -88.1078546 | |||||||||||||||
Froedtert Memorial Lutheran Hospital | Transplant | Milwaukee | WI | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceELITE | $127,000 | 30 | $1,900 Med/Surg | $2,800 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.0578056 | -88.1078546 | |||||||||||||||
Froedtert Memorial Lutheran Hospital | Transplant | Milwaukee | WI | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceELITE | $150,000 | 30 | $1,900 Med/Surg | $2,800 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.0578056 | -88.1078546 | |||||||||||||||
Froedtert Memorial Lutheran Hospital | Transplant | Milwaukee | WI | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Adult | Programs of Excellence | PerformanceELITE | 1st Autologous BMT/PSCT: $85,000 | 2nd Autologous BMT/PSCT: $85,000 | 1st Autologous BMT/PSCT: 25 | 2nd Autologous BMT/PSCT: 25 | $1,900 Med/Surg | $2,800 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.0578056 | -88.1078546 | |||||||||||||||
Froedtert Memorial Lutheran Hospital | Transplant | Milwaukee | WI | Blood/Marrow (Tandem Auto to Allo) | Tandem Auto to Allo | Adult | Programs of Excellence | PerformanceELITE | 1st Autologous BMT/PSCT: $85,000 | 2nd Allogeneic BMT/PSCT (Related Donor): $127,000 | 3rd Allogeneic BMT/PSCT (Unrelated Donor): $150,000 | 1st Autologous BMT/PSCT: 25 | 2nd Allogeneic BMT/PSCT (Related Donor): 30 | 3rd Allogeneic BMT/PSCT (Unrelated Donor): 30 | $1,900 Med/Surg | $2,800 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | 60% of Billed Charges | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.0578056 | -88.1078546 | |||||||||||||||
Froedtert Memorial Lutheran Hospital | Transplant | Milwaukee | WI | Heart | Heart | Adult | Member's Choice | $125,000 | 20 | 3200 | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost, Plus 10% | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||
Froedtert Memorial Lutheran Hospital | Transplant | Milwaukee | WI | Kidney | Kidney | Adult | Member's Choice | Cadaveric Donor: $54,000 | Living Donor: $59,000 | 17 | $1,500 Med/Surg | $1,800 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost, Plus 10% | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||
Froedtert Memorial Lutheran Hospital | Transplant | Milwaukee | WI | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $85,000 | 17 | $1,500 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost, Plus 10% | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||
Froedtert Memorial Lutheran Hospital | Transplant | Milwaukee | WI | Liver | Liver | Adult | Member's Choice | $140,000 | 20 | $1,500 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost, Plus 10% | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||
Froedtert Memorial Lutheran Hospital | Transplant | Milwaukee | WI | Lung | Lung | Adult | Member's Choice | $160,000 | 20 | $3,200 Med/Surg | $3,200 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost, Plus 10% | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||
Froedtert Memorial Lutheran Hospital | Transplant | Milwaukee | WI | Pancreas | Pancreas | Adult | Member's Choice | $55,000 | 17 | $1,500 Med/Surg | $2,500 ICU/CCU | 90% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost, Plus 10% | 60% of Billed Charges | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||
University of Wisconsin Hospital and Clinics | Transplant | Madison | WI | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $110,801 | Professional: $10,108 | 21 | Hospital: $5,698 | Professional: $751 | 90% of Billed Charges | Inpatient: $4,711 Per Diem | Outpatient & Professional: 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.084972 | -89.4766314 | |||||||||||||||
University of Wisconsin Hospital and Clinics | Transplant | Madison | WI | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | Hospital $172,460 | Professional: $18,694 | 35 | Hospital: $4,947 | Professional: $751 | 90% of Billed Charges | Inpatient: $4,711 Per Diem | Outpatient & Professional: 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.084972 | -89.4766314 | |||||||||||||||
University of Wisconsin Hospital and Clinics | Transplant | Madison | WI | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceQUALITY | Hospital $310,245 | Professional: $20,410 | 35 | Hospital: $4,947 | Professional: $751 | 90% of Billed Charges | Inpatient: $4,711 Per Diem | Outpatient & Professional: 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.084972 | -89.4766314 | |||||||||||||||
University of Wisconsin Hospital and Clinics | Transplant | Madison | WI | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $244,083| Professional: $78,973 | 13 | Hospital: $5,698 | Professional: $751 | 90% of Billed Charges | Inpatient: $4,278 Per Diem | Outpatient & Professional: 70% of Billed Charges | Included in Case Rate | Ventricular Assist Device (VAD) Shall be Reimbursed at 70% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.084972 | -89.4766314 | |||||||||||||||
University of Wisconsin Hospital and Clinics | Transplant | Madison | WI | Kidney | Kidney | Adult | Programs of Excellence | PerformanceELITE | Hospital: $88,990 | Professional: $28,990 | 7 | Hospital: $4,947 | Professional: $751 | 90% of Billed Charges | Inpatient: $4,278 Per Diem | Outpatient & Professional: 70% of Billed Charges | Included in Case Rate | Ventricular Assist Device (VAD) Shall be Reimbursed at 70% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.084972 | -89.4766314 | |||||||||||||||
University of Wisconsin Hospital and Clinics | Transplant | Madison | WI | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceSELECT | Hospital $154,830 | Professional: $47,381 | 12 | Hospital: $4,947 | Professional: $751 | 90% of Billed Charges | Inpatient: $4,278Per Diem | Outpatient & Professional: 70% of Billed Charges | Included in Case Rate | Ventricular Assist Device (VAD) Shall be Reimbursed at 70% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.084972 | -89.4766314 | |||||||||||||||
University of Wisconsin Hospital and Clinics | Transplant | Madison | WI | Liver | Liver | Adult | Programs of Excellence | PerformanceSELECT | Cadaveric Donor Hospital: $133,802 | Cadaveric Donor Professional: $91,166 | Living Donor Hospital: $151,352 | Living Donor Professional: $126,551 | Cadaveric Donor: 19 | Living Donor: 21 | Hospital: $4,947 | Professional: $751 | 90% of Billed Charges | Inpatient: $4,278 Per Diem | Outpatient & Professional: 70% of Billed Charges | Included in Case Rate | Ventricular Assist Device (VAD) Shall be Reimbursed at 70% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.084972 | -89.4766314 | |||||||||||||||
University of Wisconsin Hospital and Clinics | Transplant | Madison | WI | Lung | Lung | Adult | Programs of Excellence | PerformanceSELECT | Single Lung | Hospital: $185,555 | Professional: $47,962 | Bilateral Lung | Hospital: $336,500 | Professional: $78,051 | Single Lung: 15 | Bilateral Lung: 20 | Hospital: $4,278 | Professional: $751 | 90% of Billed Charges | Inpatient: $4,278 Per Diem | Outpatient & Professional: 70% of Billed Charges | Included in Case Rate | Ventricular Assist Device (VAD) Shall be Reimbursed at 70% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.084972 | -89.4766314 | |||||||||||||||
University of Wisconsin Hospital and Clinics | Transplant | Madison | WI | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | Hospital: $110,801 | Professional: $10,108 | 21 | Hospital: $5,698 | Professional: $751 | 90% of Billed Charges | Inpatient: $4,711 Per Diem | Outpatient & Professional: 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.084972 | -89.4766314 | ||||||||||||||||
University of Wisconsin Hospital and Clinics | Transplant | Madison | WI | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | Hospital $172,460 | Professional: $18,694 | 35 | Hospital: $4,947 | Professional: $751 | 90% of Billed Charges | Inpatient: $4,711 Per Diem | Outpatient & Professional: 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.084972 | -89.4766314 | ||||||||||||||||
University of Wisconsin Hospital and Clinics | Transplant | Madison | WI | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | Hospital $310,245 | Professional: $20,410 | 35 | Hospital: $4,947 | Professional: $751 | 90% of Billed Charges | Inpatient: $4,711 Per Diem | Outpatient & Professional: 70% of Billed Charges | Included in Case Rate | Included in Case Rate | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.084972 | -89.4766314 | ||||||||||||||||
University of Wisconsin Hospital and Clinics | Transplant | Madison | WI | Heart | Heart | Pediatric | Member's Choice | Hospital: $244,083| Professional: $78,973 | 13 | Hospital: $5,698 | Professional: $751 | 90% of Billed Charges | Inpatient: $4,278 Per Diem | Outpatient & Professional: 70% of Billed Charges | Included in Case Rate | Ventricular Assist Device (VAD) Shall be Reimbursed at 70% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.084972 | -89.4766314 | ||||||||||||||||
University of Wisconsin Hospital and Clinics | Transplant | Madison | WI | Kidney | Kidney | Pediatric | Member's Choice | Hospital: $88,990 | Professional: $28,990 | 7 | Hospital: $4,947 | Professional: $751 | 90% of Billed Charges | Inpatient: $4,278 Per Diem | Outpatient & Professional: 70% of Billed Charges | Included in Case Rate | Ventricular Assist Device (VAD) Shall be Reimbursed at 70% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.084972 | -89.4766314 | ||||||||||||||||
University of Wisconsin Hospital and Clinics | Transplant | Madison | WI | Kidney/Pancreas | Kidney/Pancreas | Pediatric | Member's Choice | Hospital $154,830 | Professional: $47,381 | 12 | Hospital: $4,947 | Professional: $751 | 90% of Billed Charges | Inpatient: $4,278Per Diem | Outpatient & Professional: 70% of Billed Charges | Included in Case Rate | Ventricular Assist Device (VAD) Shall be Reimbursed at 70% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.084972 | -89.4766314 | ||||||||||||||||
University of Wisconsin Hospital and Clinics | Transplant | Madison | WI | Liver | Liver | Pediatric | Member's Choice | Cadaveric Donor Hospital: $133,802 | Cadaveric Donor Professional: $91,166 | Living Donor Hospital: $151,352 | Living Donor Professional: $126,551 | Cadaveric Donor: 19 | Living Donor: 21 | Hospital: $4,947 | Professional: $751 | 90% of Billed Charges | Inpatient: $4,278 Per Diem | Outpatient & Professional: 70% of Billed Charges | Included in Case Rate | Ventricular Assist Device (VAD) Shall be Reimbursed at 70% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.084972 | -89.4766314 | ||||||||||||||||
University of Wisconsin Hospital and Clinics | Transplant | Madison | WI | Lung | Lung | Pediatric | Member's Choice | Single Lung | Hospital: $185,555 | Professional: $47,962 | Bilateral Lung | Hospital: $336,500 | Professional: $78,051 | Single Lung: 15 | Bilateral Lung: 20 | Hospital: $4,278 | Professional: $751 | 90% of Billed Charges | Inpatient: $4,278 Per Diem | Outpatient & Professional: 70% of Billed Charges | Included in Case Rate | Ventricular Assist Device (VAD) Shall be Reimbursed at 70% of Billed Charges | 50% of Billed Charges | Begins at Evaluation | Begins on the Day of Admission and Ends when Inlier Days and Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 43.084972 | -89.4766314 | ||||||||||||||||
Baylor University Medical Center | Cellular Immunotherapy | Dallas | TX | Cellular Immunotherapy | Cellular Immunotherapy | Hospital: 60% of Billed Charges | Professional: 70% of Billed Charges | Drug Cost: 100% of Invoice Cost | N/A | N/A | N/A | Hospital: 60% of Billed Charges | Professional: 70% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends 365 Days from Discharge | 32.8205862 | -96.871968 | ||||||||||||||||||||
Children's Hospital of Philadelphia | Cellular Immunotherapy | Philadelphia | PA | Cellular Immunotherapy | Cellular Immunotherapy | Hospital: 55% of Billed Charges | Professional: 75% of Billed Charges | Drug Cost: 100% of Wholesale Acquisition Cost (WAC) | N/A | N/A | N/A | Hospital: 60% of Billed Charges | Professional: 75% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends 365 Days from Discharge | 40.0024768 | -75.1882393 | ||||||||||||||||||||
Cincinnati Children's Hospital Medical Center | Cellular Immunotherapy | Cincinnati | OH | Cellular Immunotherapy | Cellular Immunotherapy | $142,000 | Drug Cost: 100% of Wholesale Acquisition Cost (WAC) | N/A | N/A | 90% of Billed Charges | 80% of Billed Charges | 60% of Billed Charges | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends 365 Days from Discharge | 39.136319 | -84.6106124 | ||||||||||||||||||||
Indiana University Hospital | Cellular Immunotherapy | Indianapolis | IN | Cellular Immunotherapy | Cellular Immunotherapy | $228,800 | Drug Cost: 100% of Invoice Cost | N/A | N/A | 80% of Billed Charges | 65% of Billed Charges | If Charges Exceed $468,000, Payment will be the Case Rate, Plus 59% of the Excess Charges | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends One (1) Year from Discharge | 39.7796999 | -86.2731749 | ||||||||||||||||||||
Johns Hopkins Hospital | Cellular Immunotherapy | Baltimore | MD | Cellular Immunotherapy | Cellular Immunotherapy | 100% of the State of Maryland HSCRC rates | Drug Cost: 100% of the State of Maryland HSCRC rates | For all other Services not regulated by the HSCRC | Hospital: 60% of Billed Charges | Professional: 80% of Billed Charges | N/A | N/A | N/A | 100% of the State of Maryland HSCRC rates | Professional: 80% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends 365 Days from Discharge | 39.2846853 | -76.6907077 | ||||||||||||||||||||
Mt Sinai Medical Center | Cellular Immunotherapy | New York | NY | Cellular Immunotherapy | Cellular Immunotherapy | $241,000 | Drug Cost: 100% of Invoice Cost | 35 | $3,846 (Med/Surg) | $5,384 (ICU/CCU) | $2,461 (Hospital Rehab) | 100% of Billed Charges | 75% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends 365 Days from Discharge | 40.697403 | -74.1201058 | ||||||||||||||||||||
Northside Hospital | Cellular Immunotherapy | Atlanta | GA | Cellular Immunotherapy | Cellular Immunotherapy | Charges $0 - $500,000 Pay at 60% | Charges $500,001 - $1,000,000 Pay at 55% | Charges $1,000,001 and Above Pay at 50% | Drug Cost: 105% of Invoice Cost | N/A | N/A | N/A | 60% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends 365 Days from Discharge | 33.767693 | -84.4908151 | ||||||||||||||||||||
Seattle Cancer Care Alliance | Cellular Immunotherapy | Seattle | WA | Cellular Immunotherapy | Cellular Immunotherapy | Charges $0 - $500,000 Pay at 80% | Charges $500,001 - $1,000,000 75% | Charges $1,000,001 and Above Pay at 70% | Drug Cost: 110% of Invoice Cost | N/A | N/A | N/A | 80% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends One (1) Year from Discharge | 47.613007 | -122.4122753 | ||||||||||||||||||||
Stanford Health Care | Cellular Immunotherapy | Palo Alto | CA | Cellular Immunotherapy | Cellular Immunotherapy | Charges $0 - $500,000 Pay at 60% | Charges $500,001 - $1,000,000 Pay at 50% | Charges $1,000,001 and Above Pay at 40% | Drug Cost: 110% of Invoice Cost | N/A | N/A | N/A | 60% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends 365 Days from Discharge | 37.4256448 | -122.1704551 | ||||||||||||||||||||
Lucile Salter Packard Children's Hospital at Stanford | Cellular Immunotherapy | Palo Alto | CA | Cellular Immunotherapy | Cellular Immunotherapy | Charges $0 - $500,000 Pay at 60% | Charges $500,001 - $1,000,000 Pay at 50% | Charges $1,000,001 and Above Pay at 40% | Drug Cost: 110% of Wholesale Acquisition Cost (WAC) | N/A | N/A | N/A | 60% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends One (1) Year from Discharge | 37.4256448 | -122.1704551 | ||||||||||||||||||||
Texas Children's Hospital | Cellular Immunotherapy | Houston | TX | Cellular Immunotherapy | Cellular Immunotherapy | Charges $0 - $500,000 Pay at 65% | Charges $500,001 - $1,000,000 Pay at 60% | Charges $1,000,001 and Above Pay at 55% | Drug Cost: 105% of Wholesale Acquisition Cost (WAC) | N/A | N/A | N/A | 70% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends One (1) Year from Discharge | 29.8171037 | -95.5417172 | ||||||||||||||||||||
Mayo Clinic Hospital (Arizona) | Cellular Immunotherapy | Phoenix | AZ | Cellular Immunotherapy | Cellular Immunotherapy | 75% of Billed Charges | Drug Cost: 110% of Invoice Cost | N/A | 90% of Billed Charges Drug Cost: 110% of Invoice Cost | N/A | N/A | 90% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends One (1) Year from Discharge | 33.6050976 | -112.4059148 | |||||||||||||||||||
Rochester Methodist Hospital (Mayo Clinic) | Cellular Immunotherapy | Rochester | MN | Cellular Immunotherapy | Cellular Immunotherapy | 95% of Billed Charges | Drug Cost: 110% of Invoice Cost | N/A | N/A | N/A | 95% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins at Evaluation for CAR-T Therapy Treament and Ends at Discharge | Ends One (1) Year from Discharge | 43.9959661 | -92.5513833 | ||||||||||||||||||||
Mayo Clinic Florida | Cellular Immunotherapy | Jacksonville | FL | Cellular Immunotherapy | Cellular Immunotherapy | 75% of Billed Charges | Drug Cost: 110% of Invoice Cost | N/A | N/A | N/A | 75% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins at Evaluation for CAR-T Therapy Treament and Ends at Discharge | Ends One (1) Year from Discharge | 30.344915 | -81.8235326 | ||||||||||||||||||||
Oregon Health & Science University | Cellular Immunotherapy | Portland | OR | Cellular Immunotherapy | Cellular Immunotherapy | 70% of Billed Charges | Drug Cost: 110% of Wholesale Acquisition Cost (WAC) | N/A | N/A | N/A | 70% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends One (1) Year from Discharge | 45.5426915 | -122.7245379 | ||||||||||||||||||||
Children's Hospital Los Angeles | Cellular Immunotherapy | Los Angeles | CA | Cellular Immunotherapy | Cellular Immunotherapy | Charges $0 - $500,000 Pay at 60% of Billed | Charges $500,001 - $1,000,000 Pay at 50% | Charges $1,000,001 and Above Pay at 40% | Drug Cost: 105% of Wholesale Acquisition Cost (WAC) | N/A | N/A | N/A | 60% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends One (1) Year from Discharge | 34.0201598 | -118.6925961 | ||||||||||||||||||||
University of Wisconsin Hospital and Clinics | Cellular Immunotherapy | Madison | WI | Cellular Immunotherapy | Cellular Immunotherapy | 60% of Billed Charges | Drug Cost: 110% of Wholesale Acquisition Cost (WAC) | N/A | N/A | N/A | 60% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends One (1) Year from Discharge | 43.084972 | -89.4766314 | ||||||||||||||||||||
University of Michigan Medical Center | Cellular Immunotherapy | Ann Arbor | MI | Cellular Immunotherapy | Cellular Immunotherapy | 60% of Billed Charges | Drug Cost: 105% of Invoice Cost | N/A | N/A | N/A | 70% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends 365 Days from Discharge | 42.273315 | -83.7727946 | ||||||||||||||||||||
University of Maryland Medical System | Cellular Immunotherapy | Baltimore | MD | Cellular Immunotherapy | Cellular Immunotherapy | Hospital: 100% of the State of Maryland HSCRC rates | Professional: 75% of Billed Charges | Drug Cost: 100% of HSCRC rates | N/A | N/A | N/A | Hospital: 100% of the State of Maryland HSCRC rates | Professional: 75% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends 90 Days from Discharge | 39.2846853 | -76.6907077 | ||||||||||||||||||||
City of Hope National Medical Center | Cellular Immunotherapy | Duarte | CA | Cellular Immunotherapy | Cellular Immunotherapy | 75% of Billed Charges | N/A | N/A | N/A | 75% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends 365 Days from Discharge | 34.1578544 | -117.975176 | ||||||||||||||||||||
Memorial Sloan-Kettering Cancer Center | Cellular Immunotherapy | New York | NY | Cellular Immunotherapy | Cellular Immunotherapy | Charges $0 - $1,000,000 Pay at 65% | Charges $1,000,001 and Above Pay at 60% | Drug Cost: 100% of Invoice Cost | N/A | N/A | N/A | 65% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends 365 Days from Discharge | 40.697403 | -74.1201058 | ||||||||||||||||||||
Froedtert Memorial Lutheran Hospital | Cellular Immunotherapy | Milwaukee | WI | Cellular Immunotherapy | Cellular Immunotherapy | Charges $0 - $500,000 Pay at 65% | Charges $500,001 - $1,000,000 Pay at 60% | Charges $1,000,001 and Above Pay at 55% | Drug Cost: 100% of Invoice Cost | N/A | N/A | N/A | 65% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends One (1) Year from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||||||
University of California San Diego Medical Center | Cellular Immunotherapy | San Diego | CA | Cellular Immunotherapy | Cellular Immunotherapy | Charges $0 - $500,000 Pay at 65% | Charges $500,001 - $1,000,000 Pay at 60% | Charges $1,000,001 and Above Pay at 55% | Drug Cost: 100% of Invoice Cost | N/A | N/A | N/A | 70% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends One (1) Year from Discharge | 32.8244741 | -117.249404 | ||||||||||||||||||||
University of Minnesota Medical Center, Fairview | Cellular Immunotherapy | Minneapolis | MN | Cellular Immunotherapy | Cellular Immunotherapy | 60% of Billed Charges | Drug Cost: 100% of Wholesale Acquisition Cost (WAC) | N/A | N/A | N/A | 60% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends One (1) Year from Discharge | 44.9706755 | -93.3316894 | ||||||||||||||||||||
University of Iowa Hospitals and Clinics | Cellular Immunotherapy | Iowa City | IA | Cellular Immunotherapy | Cellular Immunotherapy | Charges $0 - $1,000,000 Pay at 65% | Charges $1,000,000 & Above Pay at 60% | Drug Cost: 110% of Wholesale Acquisition Cost (WAC) | N/A | N/A | N/A | 70% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends 365 Days from Discharge | 41.6470476 | -91.5744685 | ||||||||||||||||||||
MD Anderson Cancer Center | Cellular Immunotherapy | Houston | TX | Cellular Immunotherapy | Cellular Immunotherapy | 75% of Billed Charges | Drug Cost: 100% of Invoice Cost | N/A | N/A | N/A | 75% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends 365 Days from Discharge | 29.8171037 | -95.5417172 | ||||||||||||||||||||
University of Maryland Medical System | Cellular Immunotherapy | Baltimore | MD | Cellular Immunotherapy | Cellular Immunotherapy | Hospital: 100% of HSCRC Fee Schedule | Physicians: 75% of Billed Charges | CAR-T Drug: 100% of Billed Charges | N/A | N/A | N/A | Hospital: 100% of the State of Maryland HSCRC rates | Professional: 75% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends 90 Days from Discharge | 39.2846853 | -76.6907077 | ||||||||||||||||||||
University of Kansas Hospital | Cellular Immunotherapy | Kansas City | KS | Cellular Immunotherapy | Cellular Immunotherapy | 60% of Billed Charges | Drug Cost: 100% of Wholesale Acquisition Cost (WAC) | N/A | N/A | N/A | 60% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends One (1) Year from Discharge | 39.1232139 | -94.818637 | ||||||||||||||||||||
University of Utah Medical Center | Cellular Immunotherapy | Salt Lake City | UT | Cellular Immunotherapy | Cellular Immunotherapy | 80% of Billed Charges | Drug Cost: 100% of Wholesale Acquisition Cost (WAC) | N/A | N/A | N/A | 80% of Billed Charges | N/A | Begins at Evaluation and Ends at Admission for CAR-T Therapy Treatment | Begins on the First Day of Admission for CAR-T Cell Therapy Treatment and Ends at Discharge | Ends 365 Days from Discharge | 40.7765867 | -111.990696 | ||||||||||||||||||||
Aurora St Luke's Medical Center | Transplant | Milwaukee | WI | Heart | Heart | Adult | Member's Choice | $235,000 | 18 | $4,000 Med/Surg | $5,000 ICU/CCU | N/A | 65% of Billed Charges | Included in Case Rate | Reimbursed at 50% of Hospitals Billed Charges | $470,000 | 65% of Billed Charges Beyond Threshold Amount | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Ends 180 Days from Discharge | 43.0578056 | -88.1078546 | ||||||||||||||||
Froedtert Memorial Lutheran Hospital | Destination VAD | Milwaukee | WI | Destination VAD | Destination VAD | Surgical Event: 70% of Billed Charges | N/A | N/A | 90% of Billed Charges | 70% of Billed Charges | 50% of Billed Charges | $570,000 & 65% of Billed Charges Thereafter | Begins at Evaluation | Begins on the Day of VAD Insertion and Ends at Discharge | Begins at Discharge and Remains Active Until: | (a) The Death of the Patient | (b) Patient's Insurance Coverage Terminates | (c )If Patient Receives a Heart Transplant | 43.0578056 | -88.1078546 | |||||||||||||||||||
The Nebraska Medical Center | Destination VAD | Omaha | NE | Destination VAD | Destination VAD | $285,000 | N/A | Inpatient Per Diem: $2,900 Med/Surg | $3,600 ICU/CCU | Inpatient: 90% of Billed Charges | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | 100% of Invoice Cost | Inpatient Stay: 62% of Billed Charges | Begins at Evaluation and Ends on the Day of VAD Insertion | Begins on the Day of VAD Insertion and Ends at Discharge | Begins at Discharge and Remains Active Until: | (a) The Death of the Patient | (b) Patient's Insurance Coverage Terminates | (c )If Patient Receives a Heart Transplant | 41.2918376 | -96.1514595 | |||||||||||||||||||
CHI St Luke's Health Baylor College of Medicine Medical Center | Destination VAD | Houston | TX | Destination VAD | Destination VAD | Surgical Event: 60% of Billed Charges | N/A | Inpatient Per Diem: $3,400 | 90% of Billed Charges | 70% of Billed Charges | VAD Maintenance & Supplies: 60% of Billed Charges | Revenue Codes 275, 276, 278, 279: 60% of Billed Charges | Revenue Code 624 - Category B: 100% of Billed Charges | Revenue Code 624 - Category B: 60% of Billed Charges | Inpatient Stay: 60% of Billed Charges | Begins at Evaluation and Ends on the Day of VAD Insertion | Begins on the Day of VAD Insertion and Ends at Discharge | Begins at Discharge and Remains Active Until: | (a) The Death of the Patient | (b) Patient's Insurance Coverage Terminates | (c )If Patient Receives a Heart Transplant | 29.8171037 | -95.5417172 | |||||||||||||||||||
University of Cincinnati Medical Center | Destination VAD | Cincinnati | OH | Destination VAD | Destination VAD | Surgical Event: 65% of Billed Charges | N/A | N/A | N/A | 75% of Billed Charges | 75% of Billed Charges | N/A | Begins at Evaluation and Ends on the Day of VAD Insertion | Begins on the Day of VAD Insertion and Ends at Discharge | Begins at Discharge and Remains Active Until: | (a) The Death of the Patient | (b) Patient's Insurance Coverage Terminates | (c )If Patient Receives a Heart Transplant | 39.136319 | -84.6106124 | |||||||||||||||||||
University of Chicago Medical Center | Destination VAD | Chicago | IL | Destination VAD | Destination VAD | Surgical Event: 72% of Billed Charges | N/A | Inpatient Days (Non-Surgical): $2,400 Med/Surg | $2,600 ICU/CCU | Inpatient Days: 90% of Billed Charges | 72% of Billed Charges | 55% of Billed Charges | 50% of Billed Charges | Begins at Evaluation and Ends on the Day of VAD Insertion | Begins on the Day of VAD Insertion and Ends at Discharge | Begins at Discharge and Remains Active Until: | (a) The Death of the Patient | (b) Patient's Insurance Coverage Terminates | (c )If Patient Receives a Heart Transplant | 41.8336474 | -87.8723887 | |||||||||||||||||||
University of Washington Medical Center | Destination VAD | Seattle | WA | Destination VAD | Destination VAD | Surgical Event: 75% of Billed Charges | N/A | N/A | N/A | 75% of Billed Charges | 75% of Billed Charges | N/A | Begins at Evaluation and Ends on the Day of VAD Insertion | Begins on the Day of VAD Insertion and Ends at Discharge | Begins at Discharge and Remains Active Until: | (a) The Death of the Patient | (b) Patient's Insurance Coverage Terminates | (c )If Patient Receives a Heart Transplant | 47.613007 | -122.4122753 | |||||||||||||||||||
UT Southwestern Medical Center | Destination VAD | Dallas | TX | Destination VAD | Destination VAD | Surgical Event: 75% of Billed Charges | N/A | N/A | N/A | 80% of Billed Charges | VAD Maintenance & Supplies: 110% of Medicare Reimbursement | 100% of Invoice Cost | N/A | Begins at Evaluation and Ends on the Day of VAD Insertion | Begins on the Day of VAD Insertion and Ends at Discharge | Begins at Discharge and Remains Active Until: | (a) The Death of the Patient | (b) Patient's Insurance Coverage Terminates | (c )If Patient Receives a Heart Transplant | 32.8205862 | -96.871968 | |||||||||||||||||||
Henry Ford Hospital | Destination VAD | Detroit | MI | Destination VAD | Destination VAD | 70% of Billed Charges | N/A | N/A | N/A | 70% of Billed Charges | 110% of Billed Charges | N/A | Begins at Evaluation and Ends on the Day of VAD Insertion | Begins on the Day of VAD Insertion and Ends at Discharge | Begins at Discharge and Remains Active Until: | (a) The Death of the Patient | (b) Patient's Insurance Coverage Terminates | (c )If Patient Receives a Heart Transplant | 42.3526896 | -83.1694159 | |||||||||||||||||||
Medical University of South Carolina | Destination VAD | Columbia | SC | Destination VAD | Destination VAD | $143,100 | N/A | N/A | 95% of Billed Charges | 75% of Billed Charges | 55% of Billed Charges | $286,200 & 70% of Billed Charges Thereafter | Begins at Evaluation and Ends on the Day of VAD Insertion | Begins on the Day of VAD Insertion and Ends at Discharge | Begins at Discharge and Remains Active Until: | (a) The Death of the Patient | (b) Patient's Insurance Coverage Terminates | (c )If Patient Receives a Heart Transplant | 34.037489 | -81.0077761 | |||||||||||||||||||
Ohio State University Medical Center | Destination VAD | Columbus | OH | Destination VAD | Destination VAD | Surgical Event: 75% of Billed Charges | N/A | N/A | N/A | VAD Maintenance, Including Outpatient VAD Suppplies and Accessories: 65% of Billed Charges | 65% of Billed Charges | N/A | Begins at Evaluation and Ends on the Day of VAD Insertion | Begins on the Day of VAD Insertion and Ends at Discharge | Begins at Discharge and Remains Active Until: | (a) The Death of the Patient | (b) Patient's Insurance Coverage Terminates | (c )If Patient Receives a Heart Transplant | 39.9828667 | -83.1312539 | |||||||||||||||||||
University of Alabama Hospital | Destination VAD | Birmingham | AL | Destination VAD | Destination VAD | Lesser of 85% of Billed Charges or $141,799 | If Charges Exceed $212,500, 85% of Billed Charges Thereafter | 4 | N/A | 85% of Billed Charges | 90% of Billed Charges | Included in the Case Rate | $212,500 & 85% of Billed Charges Thereafter | Begins at Evaluation and Ends on the Day of VAD Insertion | Begins on the Day of VAD Insertion and Ends at Discharge | Begins at Discharge and Remains Active Until: | (a) The Death of the Patient | (b) Patient's Insurance Coverage Terminates | (c )If Patient Receives a Heart Transplant | 33.5312176 | -86.9203481 | |||||||||||||||||||
Ochsner Foundation Hospital | Destination VAD | Jefferson | LA | Destination VAD | Destination VAD | Surgical Event: 75% of Billed Charges | N/A | Inpatient Per Diem: $7,500 | Inpatient Services: Lesser of 80% of Billed Charges or $7,500 | Outpatient Care: 75% of Billed Charges | 75% of Billed Charges | Inpatient Services: Lesser of 80% of Billed Charges or $7,500, but never less than 55% of Billed Charges | Begins at Evaluation and Ends on the Day of VAD Insertion | Begins on the Day of VAD Insertion and Ends at Discharge | Begins at Discharge and Remains Active Until: | (a) The Death of the Patient | (b) Patient's Insurance Coverage Terminates | (c )If Patient Receives a Heart Transplant | 29.9589168 | -90.1856199 | |||||||||||||||||||
Oregon Health & Science University | Destination VAD | Portland | OR | Destination VAD | Destination VAD | Surgical Event Hospital: $418,080 | Surgical Event Professional: 70% of Billed Charges | N/A | N/A | 90% of Billed Charges | 70% of Billed Charges | Included in the Hospital Case Rate | Charges that Exceed 180% ($752,400) of the Applicable Surgical Event Case Rate (Hospital), Shall be Reimbursed at 75% of Billed Charges | Begins at Evaluation and Ends on the Day of VAD Insertion | Begins on the Day of VAD Insertion and Ends at Discharge | Begins at Discharge and Remains Active Until: | (a) The Death of the Patient | (b) Patient's Insurance Coverage Terminates | (c )If Patient Receives a Heart Transplant | 45.5426915 | -122.7245379 | |||||||||||||||||||
University of Utah Medical Center | Destination VAD | Salt Lake City | UT | Destination VAD | Destination VAD | Surgical Event: 72% of Billed Charges | N/A | Inpatient Per Diem: $2,386 | Inpatient Services: Lesser of 90% of Billed Charges or $2,386 | Outpatient Care: 80% of Billed Charges | 100% of Invoice Cost | Inpatient Services: Lesser of 90% of Billed Charges or $2,288, but never less than 45% of Billed Charges | Begins at Evaluation and Ends on the Day of VAD Insertion | Begins on the Day of VAD Insertion and Ends at Discharge | Begins at Discharge and Remains Active Until: | (a) The Death of the Patient | (b) Patient's Insurance Coverage Terminates | (c )If Patient Receives a Heart Transplant | 40.7765867 | -111.990696 | |||||||||||||||||||
Cedars-Sinai Medical Center | Destination VAD | Los Angeles | CA | Destination VAD | Destination VAD | Surgical Event Hospital: 55% of Billed Charges | Surgical Event Professional: 60% of Billed Charges | N/A | Inpatient Care: Hospital 55% of Billed Charges | Professional 60% of Billed Charges | N/A | Outpatient Care: Hospital 55% of Billed Charges; Professional 60% of Billed Charges | 55% of Billed Charges | N/A | Begins at Evaluation and Ends on the Day of VAD Insertion | Begins on the Day of VAD Insertion and Ends at Discharge | Begins at Discharge and Remains Active Until: | (a) The Death of the Patient | (b) Patient's Insurance Coverage Terminates | (c )If Patient Receives a Heart Transplant | 34.0201598 | -118.6925961 | |||||||||||||||||||
Thomas Jefferson University Hospital | Destination VAD | Philadelphia | PA | Destination VAD | Destination VAD | Surgical Event: 70% of Billed Charges | N/A | Inpatient Per Diem: $3,976 | Inpatient Services: Lesser of 90% of Billed Charges or $3,976 | 70% of Billed Charges | VAD Maintenance & Supplies: 115% of Invoice Cost | 100% of Invoice Cost | Inpatient Services: Lesser of 90% of Billed Charges or $3,976, but never less than 50% of Billed Charges | Begins at Evaluation and Ends on the Day of VAD Insertion | Begins on the Day of VAD Insertion and Ends at Discharge | Begins at Discharge and Remains Active Until: | (a) The Death of the Patient | (b) Patient's Insurance Coverage Terminates | (c )If Patient Receives a Heart Transplant | 40.0024768 | -75.1882393 | |||||||||||||||||||
University of North Carolina Hospitals | Destination VAD | Chapel Hill | NC | Destination VAD | Destination VAD | Surgical Event: 75% of Billed Charges | N/A | Hospital: 75% of Billed Charges | Professional: 65% of Billed Charges | N/A | 65% of Billed Charges | 75% of Billed Charges | N/A | Begins at Evaluation and Ends on the Day of VAD Insertion | Begins on the Day of VAD Insertion and Ends at Discharge | Begins at Discharge and Remains Active Until: | (a) The Death of the Patient | (b) Patient's Insurance Coverage Terminates | (c )If Patient Receives a Heart Transplant | 35.9209539 | -79.0743961 | |||||||||||||||||||
Cincinnati Children's Hospital Medical Center | Destination VAD | Cincinnati | OH | Destination VAD | Destination VAD | Surgical Event: 70% of Billed Charges | N/A | 70% of Billed Charges | N/A | 80% of Billed Charges | VAD Maintenance & Supplies: 105% of Invoice Cost | 105% of Invoice Cost | N/A | Begins at Evaluation and Ends on the Day of VAD Insertion | Begins on the Day of VAD Insertion and Ends at Discharge | Begins at Discharge and Remains Active Until: | (a) The Death of the Patient | (b) Patient's Insurance Coverage Terminates | (c )If Patient Receives a Heart Transplant | 39.136319 | -84.6106124 | |||||||||||||||||||
University of California San Diego Medical Center | Destination VAD | San Diego | CA | Destination VAD | Destination VAD | Surgical Event: 60% of Billed Charges | N/A | Hospital: $6,000 Per Diem | Professional: 170% Medicare Fee Schedule | N/A | 65% of Billed Charges | VAD Maintenance & Supplies: 105% of Invoice Cost | 45% of Billed Charges | N/A | Begins at Evaluation and Ends on the Day of VAD Insertion | Begins on the Day of VAD Insertion and Ends at Discharge | Begins at Discharge and Remains Active Until: | (a) The Death of the Patient | (b) Patient's Insurance Coverage Terminates | (c )If Patient Receives a Heart Transplant | 32.8244741 | -117.249404 | |||||||||||||||||||
Tufts Medical Center | Destination VAD | Boston | MA | Destination VAD | Destination VAD | Surgical Event: 60% of Billed Charges | N/A | Hospital: $3,500 | Professional: $500 | 100% of Billed Charges | 70% of Billed Charges | VAD Maintenance & Supplies: 105% of Invoice Cost | 100% of Invoice Cost | N/A | Begins at Evaluation and Ends on the Day of VAD Insertion | Begins on the Day of VAD Insertion and Ends at Discharge | Begins at Discharge and Remains Active Until: | (a) The Death of the Patient | (b) Patient's Insurance Coverage Terminates | (c )If Patient Receives a Heart Transplant | 42.3143285 | -71.0404949 | |||||||||||||||||||
University of Kentucky Medical Center | Destination VAD | Lexington | KY | Destination VAD | Destination VAD | Surgical Event: 60% of Billed Charges | N/A | $3,183 | 90% of Billed Charges | 70% of Billed Charges | VAD Maintenance & Supplies: 55% of Billed Charges | 55% of Billed Charges | 50% of Billed Charges | Begins at Evaluation and Ends on the Day of VAD Insertion | Begins on the Day of VAD Insertion and Ends at Discharge | Begins at Discharge and Remains Active Until: | (a) The Death of the Patient | (b) Patient's Insurance Coverage Terminates | (c )If Patient Receives a Heart Transplant | 38.0282464 | -84.6119901 | |||||||||||||||||||
Children's Hospital Colorado | Congenital Heart Defect | Aurora | CO | Congenital Heart Defect | Congenital Heart Defect | Surgical Event Hospital: 65% of Billed Charges | Surgical Event Professional: 75% of Billed Charges | (Med/Surg) Hospital: 65% of Billed Charges | (Med/Surg) Professional: 75% of Billed Charges | (NICU/PICU) Hospital: $2,970 Per Diem | (NICU/PICU) Professional: 75% of Billed Charges | (ECMO) Hospital: $5,000 Per Diem | (ECMO) Professional: 75% of Billed Charges | N/A | N/A | N/A | Hospital: 80% of Billed Charges | Professional: 75% of Billed Charges | 105% of Billed Charges | 65% of Billed Charges | Begins on the Date of Referral to INTERLINK | Begins Upon Referral to INTERLINK &/Or when Patient is Admitted to Facility | Coverage Remains Active Until Patient No Longer Requires Pediatric Heart Services | 39.6888139 | -104.7570445 | |||||||||||||||||||
Boston Children's Hospital | Congenital Heart Defect | Boston | MA | Congenital Heart Defect | Congenital Heart Defect | Hospital: Surgical Event & Inpatient (Med/Surg/NICU/PICU) = 80% of Billed Charges | Professional: Surgical Event & Inpatient (Med/Surg/NICU/PICU) = 85% of Billed Charges | N/A | N/A | N/A | Hospital: 80% of Billed Charges | Professional: 85% of Billed Charges | During Inpatient Stay: 80% of Billed Charges | Otherwise: 85% of Billed Charges | N/A | Begins on the Date of Referral to INTERLINK | Begins Upon Referral to INTERLINK &/Or when Patient is Admitted to Facility | Coverage Remains Active Until Patient No Longer Requires Pediatric Heart Services | 42.3143285 | -71.0404949 | |||||||||||||||||||
Children's Hospital of Wisconsin | Congenital Heart Defect | Milwaukee | WI | Congenital Heart Defect | Congenital Heart Defect | 75% of Billed Charges | N/A | N/A | N/A | 75% of Billed Charges | 75% of Billed Charges | N/A | Begins on the Date of Referral to INTERLINK | Begins Upon Referral to INTERLINK &/Or when Patient is Admitted to Facility | Coverage Remains Active Until Patient No Longer Requires Pediatric Heart Services | 43.0578056 | -88.1078546 | |||||||||||||||||||
Children's Medical Center of Dallas | Congenital Heart Defect | Dallas | TX | Congenital Heart Defect | Congenital Heart Defect | Hospital: 71% of Billed Charges | Professional: 70% of Billed Charges | N/A | N/A | N/A | Hospital: 71% of Billed Charges | Professional: 70% of Billed Charges | N/A | N/A | Begins on the Date of Referral to INTERLINK | Begins Upon Referral to INTERLINK &/Or when Patient is Admitted to Facility | Coverage Remains Active Until Patient No Longer Requires Pediatric Heart Services | 32.8205862 | -96.871968 | |||||||||||||||||||
Texas Children's Hospital | Congenital Heart Defect | Houston | TX | Congenital Heart Defect | Congenital Heart Defect | Surgical Event Hospital: 60% of Billed Charges | Surgical Event Professional: 70% of Billed Charges | Inpatient (Med/Surg) Hospital: $1,800 Per Diem | Inpatient (Med/Surg) Professional: 70% of Billed Charges | Inpatient (NICU/PICU) Hospital: $2,970 Per Diem | Inpatient (NICU/PICU) Professional: 70% of Billed Charges | Inpatient (ECMO) Hospital: $5,000 Per Diem | Inpatient (ECMO) Professional: 70% of Billed Charges | N/A | N/A | N/A | 70% of Billed Charges | 105% of Billed Charges | N/A | Begins on the Date of Referral to INTERLINK | Begins Upon Referral to INTERLINK &/Or when Patient is Admitted to Facility | Coverage Remains Active Until Patient No Longer Requires Pediatric Heart Services | 29.8171037 | -95.5417172 | |||||||||||||||||||
Children's Hospital Los Angeles | Congenital Heart Defect | Los Angeles | CA | Congenital Heart Defect | Congenital Heart Defect | Surgical Event: 60% of Billed Charges | Inpatient (Med/Surg) Hospital: $3,500 Per Diem | Inpatient (Med/Surg) Professional: 60% of Billed Charges | Inpatient (NICU/PICU) Hospital: $6,500 Per Diem | Inpatient (NICU/PICU) Professional 60% of Billed Charges | Inpatient (CICU): $7,500 Per Diem | Inpatient (ECMO): 60% of Billed Charges | N/A | N/A | 100% of Billed Charges | 75% of Billed Charges | 46% of Billed Charges | 60% of Billed Charges | Begins on the Date of Referral to INTERLINK | Begins Upon Referral to INTERLINK &/Or when Patient is Admitted to Facility | Coverage Remains Active Until Patient No Longer Requires Pediatric Heart Services | 34.0201598 | -118.6925961 | |||||||||||||||||||
Cincinnati Children's Hospital Medical Center | Congenital Heart Defect | Cincinnati | OH | Congenital Heart Defect | Congenital Heart Defect | Surgical Event Inpatient Services (ECMO): 70% of Billed Charges | N/A | N/A | N/A | 80% of Billed Charges | 105% of Billed Charges | N/A | Begins on the Date of Referral to INTERLINK | Begins Upon Referral to INTERLINK &/Or when Patient is Admitted to Facility | Coverage Remains Active Until Patient No Longer Requires Pediatric Heart Services | 39.136319 | -84.6106124 | |||||||||||||||||||
Phoenix Children's Hospital | Congenital Heart Defect | Phoenix | AZ | Congenital Heart Defect | Congenital Heart Defect | Inpatient & Outpatient Services: 70% of Billed Charges | N/A | N/A | N/A | Inpatient & Outpatient Services: 70% of Billed Charges | 110% of Invoice Cost | N/A | Begins on the Date of Referral to INTERLINK | Begins Upon Referral to INTERLINK &/Or when Patient is Admitted to Facility | Coverage Remains Active Until Patient No Longer Requires Pediatric Heart Services | 33.6050976 | -112.4059148 | |||||||||||||||||||
Jackson Memorial Hospital University of Miami School of Medicine | Congenital Heart Defect | Miami | FL | Congenital Heart Defect | Congenital Heart Defect | Hospital: 75% of Billed Charges | Professional: 80% of Billed Charges | N/A | N/A | N/A | Hospital: 75% of Billed Charges | Professional: 80% of Billed Charges | 70% of Billed Charges | N/A | Begins on the Date of Referral to INTERLINK | Begins Upon Referral to INTERLINK &/Or when Patient is Admitted to Facility | Coverage Remains Active Until Patient No Longer Requires Pediatric Heart Services | 25.7824033 | -80.2645636 | |||||||||||||||||||
Ochsner Foundation Hospital | Bariatric | Jefferson | LA | Bariatric | Bariatric | DRG 619 Hospital: $32,500 | DRG 619 Professional: 70% of Billed Charges | DRG 620 Hospital: $21,500 | DRG 620 Professional: 70% of Billed Charges | DRG 621 Hospital: $17,000 | DRG 621 Professional: 70% of Billed Charges | DRG 987 Hospital: $40,000 | DRG 987 Professional: 70% of Billed Charges | DRG 988 Hospital: $20,000 | DRG 988 Professional: 70% of Billed Charges | DRG 989 Hospital: $13,000 | DRG 989 Professional: 70% of Billed Charges | DRG 619: 3 | DRG 620: 3 | DRG 621: 2 | DRG 987: 3 | DRG 988: 3 | DRG 989: 2 | $2,500 | 80% of Billed Charges | 70% of Billed Charges | N/A | Begins at Evaluation | Begins on the Day of Surgery and Ends when the Number of Inlier Days and Applicable Outlier Days have Expired | Begins at Discharge and Ends One (1) Year Later | 29.9589168 | -90.1856199 | ||||||||||||||||||||
Oregon Health & Science University | Bariatric | Portland | OR | Bariatric | Bariatric | Gastric Banding, Realize Band, Lap-Band: $17,160 | Gastric Bypass, Biliopancreatic Bypass: $28,080 | Gastric Sleeve: $17,420 | Duodenal Switch: $30,680 | Professional: 75% of Billed Charges | Gastric Banding, Realize Band, Lap-Band: 2 | Gastric Bypass, Biliopancreatic Bypass: 3 | Gastric Sleeve: 2 | Duodenal Switch: 3 | Hospital: $5,044 | Professional: 75% of Billed Charges | 90% of Billed Charges | Hospital: 70% of Billed Charges | Professional: 75% of Billed Charges | 55% of Billed Charges | Begins at Evaluation | Begins on the Day of Surgery and Ends when the Number of Inlier Days and Applicable Outlier Days have Expired | Begins at Discharge and Ends One (1) Year Later | 45.5426915 | -122.7245379 | ||||||||||||||||||||
CHI St Luke's Health Baylor College of Medicine Medical Center | Bariatric | Houston | TX | Bariatric | Bariatric | DRG 619 Hospital: $16,359 | DRG 619 Professional: 70% of Billed Charges | DRG 620 Hospital: $11,452 | DRG 620 Professional: 70% of Billed Charges | DRG 621 Hospital: $9,995 | DRG 621 Professional: 70% of Billed Charges | DRG 987 Hospital: $16,878 | DRG 987 Professional: 70% of Billed Charges | DRG 988 Hospital: $11,923 | DRG 988 Professional: 70% of Billed Charges | DRG 989 Hospital: $9,659 | DRG 989 Professional: 70% of Billed Charges | DRG 619: 3 | DRG 620: 2 | DRG 621: 2 | DRG 987: 3 | DRG 988: 2 | DRG 989: 2 | Hospital: $2,500 | Professional: 70% of Billed Charges | N/A | Hospital: 70% of Billed Charges | Professional: 70% of Billed Charges | N/A | Begins at Evaluation | Begins on the Day of Surgery and Ends when the Number of Inlier Days and Applicable Outlier Days have Expired | Begins at Discharge and Ends One (1) Year Later | 29.8171037 | -95.5417172 | ||||||||||||||||||||
University of Cincinnati Medical Center | Bariatric | Cincinnati | OH | Bariatric | Bariatric | Duodenal Switch: $16,000 | Gastric Banding: $15,000 | Gastric Bypass: $18,000 | Gastric Sleeve: $11,000 | Duodenal Switch: 3 | Gastric Banding: 2 | Gastric Bypass: 3 | Gastric Sleeve: 2 | $2,500 | 80% of Billed Charges | 70% of Billed Charges | N/A | Begins at Evaluation | Begins on the Day of Surgery and Ends when the Number of Inlier Days and Applicable Outlier Days have Expired | Begins at Discharge and Ends One (1) Year Later | 39.136319 | -84.6106124 | ||||||||||||||||||||
University of Chicago Medical Center | Bariatric | Chicago | IL | Bariatric | Bariatric | Duodenal Switch: $25,000 | Gastric Banding: $15,000 | Gastric Bypass: $25,000 | Gastric Sleeve: $11,000 | Duodenal Switch: 3 | Gastric Banding: 2 | Gastric Bypass: 3 | Gastric Sleeve: 2 | $2,500 | 80% of Billed Charges | 72% of Billed Charges | 62% of Billed Charges | Begins at Evaluation | Begins on the Day of Surgery and Ends when the Number of Inlier Days and Applicable Outlier Days have Expired | Begins at Discharge and Ends One (1) Year Later | 41.8336474 | -87.8723887 | ||||||||||||||||||||
Froedtert Memorial Lutheran Hospital | Bariatric | Milwaukee | WI | Bariatric | Bariatric | Gastric Banding: $32,011 | Gastric Bypass: $33,911 | Gastric Sleeve: $21,810 | Gastric Banding: 2 | Gastric Bypass: 3 | Gastric Sleeve: 2 | $3,519 | 100% of Billed Charges | 70% of Billed Charges | N/A | Begins at Evaluation | Begins on the Day of Surgery and Ends when the Number of Inlier Days and Applicable Outlier Days have Expired | Begins at Discharge and Ends One (1) Year Later | 43.0578056 | -88.1078546 | ||||||||||||||||||||
Cedars-Sinai Medical Center | Bariatric | Los Angeles | CA | Bariatric | Bariatric | Duodenal Switch: $28,000 | Gastric Banding: $23,000 | Gastric Bypass: $26,000 | Gastric Sleeve: $16,000 | All Professional Services: 60% of Billed Charges | Duodenal Switch: 3 | Gastric Banding: 2 | Gastric Bypass: 3 | Gastric Sleeve: 2 | $5,000 | 100% of Billed Charges | Hospital: 70% of Billed Charges | Professional: 60% of Billed Charges | 50% of Billed Charges | Begins at Evaluation and Ends on the Day of Surgery | Begins on the Day of Surgery and Ends when the Number of Inlier Days and Applicable Outlier Days have Expired | Begins at Discharge and Ends One (1) Year Later | 34.0201598 | -118.6925961 | ||||||||||||||||||||
Medical University of South Carolina | Bariatric | Columbia | SC | Bariatric | Bariatric | Duodenal Switch: $27,870 | Gastric Banding: $12,649 | Gastric Bypass: $20,870 | Gastric Sleeve: $18,912 | Duodenal Switch: 3 | Gastric Banding: 1 | Gastric Bypass: 3 | Gastric Sleeve: 2 | $3,000 | 95% of Billed Charges | 75% of Billed Charges | N/A | Begins at Evaluation and Ends on the Day of Surgery | Begins on the Day of Surgery and Ends when the Number of Inlier Days and Applicable Outlier Days have Expired | Begins at Discharge and Ends One (1) Year Later | 34.037489 | -81.0077761 | ||||||||||||||||||||
Thomas Jefferson University Hospital | Bariatric | Philadelphia | PA | Bariatric | Bariatric | Duodenal Switch: $19,056 | Gastric Banding: $17,865 | Gastric Bypass: Hospital: $20,247; Professional: $5,598 | Gastric Sleeve: Hospital: $29,775; Professional $4,883 | Duodenal Switch: 3 | Gastric Banding: 2 | Gastric Bypass: 3 | Gastric Sleeve: 2 | $2,978 | 80% of Billed Charges | 70% of Billed Charges | N/A | Begins at Evaluation and Ends on the Day of Surgery | Begins on the Day of Surgery and Ends when the Number of Inlier Days and Applicable Outlier Days have Expired | Begins at Discharge and Ends One (1) Year Later | 40.0024768 | -75.1882393 | ||||||||||||||||||||
University of California San Diego Medical Center | Bariatric | San Diego | CA | Bariatric | Bariatric | Gastric Banding: $17,000 | Gastric Bypass: $22,000 | Gastric Sleeve: $17,000 | 2 | $5,250 | 80% of Billed Charges | 65% of Billed Charges | N/A | Begins at Evaluation and Ends on the Day of Surgery | Begins on the Day of Surgery and Ends when Inlier Days and Applicable Outlier Days have Expired | Begins when Inlier Days and Applicable Outlier Days have Expired and Ends One Year from Discharge | 32.8244741 | -117.249404 | ||||||||||||||||||||
City of Hope National Medical Center | Cancer | Duarte | CA | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 34.1578544 | -117.975176 | ||||||||||||||||||||||||||||
University of California San Francisco Medical Center | Cancer | San Francisco | CA | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 37.7576948 | -122.4727051 | ||||||||||||||||||||||||||||
Memorial Sloan-Kettering Cancer Center | Cancer | New York | NY | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 40.697403 | -74.1201058 | ||||||||||||||||||||||||||||
St Jude Children's Research Hospital | Cancer | Memphis | TN | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 35.129105 | -90.1112123 | ||||||||||||||||||||||||||||
Seattle Cancer Care Alliance | Cancer | Seattle | WA | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 47.613007 | -122.4122753 | ||||||||||||||||||||||||||||
University of Wisconsin Hospital and Clinics | Cancer | Madison | WI | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 43.084972 | -89.4766314 | ||||||||||||||||||||||||||||
Stanford Health Care | Cancer | Palo Alto | CA | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 37.4256448 | -122.1704551 | ||||||||||||||||||||||||||||
University of Utah Medical Center | Cancer | Salt Lake City | UT | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 40.7765867 | -111.990696 | ||||||||||||||||||||||||||||
Mayo Clinic Hospital (Arizona) | Cancer | Phoenix | AZ | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 33.6050976 | -112.4059148 | ||||||||||||||||||||||||||||
University of Colorado Hospital | Cancer | Aurora | CO | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 39.6888139 | -104.7570445 | ||||||||||||||||||||||||||||
Rochester Methodist Hospital (Mayo Clinic) | Cancer | Rochester | MN | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 43.9959661 | -92.5513833 | ||||||||||||||||||||||||||||
The Nebraska Medical Center | Cancer | Omaha | NE | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 41.2918376 | -96.1514595 | ||||||||||||||||||||||||||||
UT Southwestern Medical Center | Cancer | Dallas | TX | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 32.8205862 | -96.871968 | ||||||||||||||||||||||||||||
University of Michigan Medical Center | Cancer | Ann Arbor | MI | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 42.273315 | -83.7727946 | ||||||||||||||||||||||||||||
Johns Hopkins Hospital | Cancer | Baltimore | MD | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 39.2846853 | -76.6907077 | ||||||||||||||||||||||||||||
Duke University Hospital | Cancer | Durham | NC | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 36.0018064 | -78.9551221 | ||||||||||||||||||||||||||||
Mayo Clinic Florida | Cancer | Jacksonville | FL | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 30.344915 | -81.8235326 | ||||||||||||||||||||||||||||
Dana-Farber Cancer Institute | Cancer | Boston | MA | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 42.3143285 | -71.0404949 | ||||||||||||||||||||||||||||
IUH - Indiana University Medical Center | Cancer | Indianapolis | IN | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 39.7796999 | -86.2731749 | ||||||||||||||||||||||||||||
MD Anderson Cancer Center | Cancer | Houston | TX | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 29.8171037 | -95.5417172 | ||||||||||||||||||||||||||||
Moffitt Cancer Center | Cancer | Tampa | FL | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 27.9944112 | -82.5947063 | ||||||||||||||||||||||||||||
Medical University of South Carolina | Cancer | Columbia | SC | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 34.037489 | -81.0077761 | ||||||||||||||||||||||||||||
University of California San Diego Medical Center | Cancer | San Diego | CA | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 32.8244741 | -117.249404 | ||||||||||||||||||||||||||||
Oregon Health & Science University | Cancer | Portland | OR | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 45.5426915 | -122.7245379 | ||||||||||||||||||||||||||||
University of Iowa Hospitals and Clinics | Cancer | Iowa City | IA | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 41.6470476 | -91.5744685 | ||||||||||||||||||||||||||||
University Hospitals of Cleveland | Cancer | Cleveland | OH | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 41.4975107 | -81.7760709 | ||||||||||||||||||||||||||||
University of Alabama Hospital | Cancer | Birmingham | AL | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 33.5312176 | -86.9203481 | ||||||||||||||||||||||||||||
Vanderbilt University Medical Center | Cancer | Nashville | TN | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 36.1865585 | -86.9256707 | ||||||||||||||||||||||||||||
Northwestern Memorial Hospital | Cancer | Chicago | IL | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 41.8336474 | -87.8723887 | ||||||||||||||||||||||||||||
Oregon Health & Science University | Transplant | Portland | OR | Heart | Heart | Adult | Government Rates | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | N/A | N/A | N/A | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | 200% of Medicare Cost Report | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 45.5426915 | -122.7245379 | ||||||||||||||||
Oregon Health & Science University | Transplant | Portland | OR | Kidney/Pancreas | Kidney/Pancreas | Adult | Government Rates | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | N/A | N/A | N/A | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | 200% of Medicare Cost Report | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 45.5426915 | -122.7245379 | ||||||||||||||||
Oregon Health & Science University | Transplant | Portland | OR | Liver | Liver | Adult | Government Rates | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | N/A | N/A | N/A | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | 200% of Medicare Cost Report | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 45.5426915 | -122.7245379 | ||||||||||||||||
Oregon Health & Science University | Transplant | Portland | OR | Pancreas | Pancreas | Adult | Government Rates | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | N/A | N/A | N/A | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | 200% of Medicare Cost Report | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 45.5426915 | -122.7245379 | ||||||||||||||||
Oregon Health & Science University | Transplant | Portland | OR | Kidney | Kidney | Adult | Government Rates | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | N/A | N/A | N/A | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | 200% of Medicare Cost Report | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 45.5426915 | -122.7245379 | ||||||||||||||||
Oregon Health & Science University | Transplant | Portland | OR | Blood/Marrow (Autologous) | Autologous | Pediatric | Government Rates | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | N/A | N/A | N/A | N/A | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | 100% of Invoice Cost | N/A | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 45.5426915 | -122.7245379 | |||||||||||||||
Oregon Health & Science University | Transplant | Portland | OR | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Government Rates | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | N/A | N/A | N/A | N/A | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | 100% of Invoice Cost | N/A | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 45.5426915 | -122.7245379 | |||||||||||||||
Oregon Health & Science University | Transplant | Portland | OR | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Government Rates | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | N/A | N/A | N/A | N/A | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | 100% of Invoice Cost | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 45.5426915 | -122.7245379 | |||||||||||||||
Oregon Health & Science University | Transplant | Portland | OR | Blood/Marrow (Autologous) | Autologous | Adult | Government Rates | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | N/A | N/A | N/A | N/A | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | 100% of Invoice Cost | N/A | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 45.5426915 | -122.7245379 | |||||||||||||||
Oregon Health & Science University | Transplant | Portland | OR | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Government Rates | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | N/A | N/A | N/A | N/A | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | 100% of Invoice Cost | N/A | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 45.5426915 | -122.7245379 | |||||||||||||||
Oregon Health & Science University | Transplant | Portland | OR | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Government Rates | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | N/A | N/A | N/A | N/A | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | 100% of Invoice Cost | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 45.5426915 | -122.7245379 | |||||||||||||||
Oregon Health & Science University | Transplant | Portland | OR | Blood/Marrow (Tandem) | Tandem Auto-to-Auto | Adult | Government Rates | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | N/A | N/A | N/A | N/A | Hospital: 200% of Medicare Fee Schedule | Professional: 70% of Billed Charges | 100% of Invoice Cost | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 45.5426915 | -122.7245379 | |||||||||||||||
Keck Hospital of USC | Transplant | Los Angeles | CA | Heart | Heart | Adult | Government Rates | Hospital: 125% of Medicare Fee Schedule | Professional: 125% of Medicare Fee Schedule | N/A | N/A | N/A | Hospital: 125% of Medicare Fee Schedule | Professional: 125% of Medicare Fee Schedule | $65,000 (Includes Transportation Costs) | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 34.0201598 | -118.6925961 | ||||||||||||||||
Keck Hospital of USC | Transplant | Los Angeles | CA | Heart/Lung | Heart/Lung | Adult | Government Rates | Hospital: 125% of Medicare Fee Schedule | Professional: 125% of Medicare Fee Schedule | N/A | N/A | N/A | Hospital: 125% of Medicare Fee Schedule | Professional: 125% of Medicare Fee Schedule | $65,000 (Includes Transportation Costs) | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 34.0201598 | -118.6925961 | ||||||||||||||||
Keck Hospital of USC | Transplant | Los Angeles | CA | Kidney | Kidney | Adult | Government Rates | Hospital: 125% of Medicare Fee Schedule | Professional: 125% of Medicare Fee Schedule | N/A | N/A | N/A | Hospital: 125% of Medicare Fee Schedule | Professional: 125% of Medicare Fee Schedule | $65,000 (Includes Transportation Costs) | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 34.0201598 | -118.6925961 | ||||||||||||||||
Keck Hospital of USC | Transplant | Los Angeles | CA | Kidney/Liver | Kidney/Liver | Adult | Government Rates | Hospital: 125% of Medicare Fee Schedule | Professional: 125% of Medicare Fee Schedule | N/A | N/A | N/A | Hospital: 125% of Medicare Fee Schedule | Professional: 125% of Medicare Fee Schedule | $65,000 (Includes Transportation Costs) | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 34.0201598 | -118.6925961 | ||||||||||||||||
Keck Hospital of USC | Transplant | Los Angeles | CA | Kidney/Pancreas | Kidney/Pancreas | Adult | Government Rates | Hospital: 125% of Medicare Fee Schedule | Professional: 125% of Medicare Fee Schedule | N/A | N/A | N/A | Hospital: 125% of Medicare Fee Schedule | Professional: 125% of Medicare Fee Schedule | $65,000 (Includes Transportation Costs) | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 34.0201598 | -118.6925961 | ||||||||||||||||
Keck Hospital of USC | Transplant | Los Angeles | CA | Liver | Liver | Adult | Government Rates | Hospital: 125% of Medicare Fee Schedule | Professional: 125% of Medicare Fee Schedule | N/A | N/A | N/A | Hospital: 125% of Medicare Fee Schedule | Professional: 125% of Medicare Fee Schedule | $65,000 (Includes Transportation Costs) | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 34.0201598 | -118.6925961 | ||||||||||||||||
Keck Hospital of USC | Transplant | Los Angeles | CA | Lung | Lung | Adult | Government Rates | Hospital: 125% of Medicare Fee Schedule | Professional: 125% of Medicare Fee Schedule | N/A | N/A | N/A | Hospital: 125% of Medicare Fee Schedule | Professional: 125% of Medicare Fee Schedule | $65,000 (Includes Transportation Costs) | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 34.0201598 | -118.6925961 | ||||||||||||||||