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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 | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | ||||||||||||||||
| 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 | ||||||||||||||||
| Alfred I DuPont Hospital for Children | Transplant | Wilmington | DE | Kidney | Kidney | Pediatric | Member's Choice | $75,000 | 15 | $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 | ||||||||||||||||
| 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 | ||||||||||||||||
| Arthur G James Cancer Hospital | Transplant | Columbus | OH | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | $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 | PerformanceQUALITY | $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 | PerformanceQUALITY | $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 | |||||||||||||||
| 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 | Blood/Marrow (Tandem) | 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 | If Billed Charges Exceed $388,000, 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 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 | ||||||||||||||||
| Aurora St Luke's Medical Center | Transplant | Milwaukee | WI | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | $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 | |||||||||||||||
| 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 | ||||||||||||||||
| Barnes-Jewish Hospital | Transplant | St Louis | MO | Heart/Lung | Heart/Lung | Adult | Member's Choice | 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 | ||||||||||||||||
| 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 | ||||||||||||||||
| Barnes-Jewish Hospital | Transplant | St Louis | MO | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | Hospital: $190,230 | Professional: $33,257 | 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 | Programs of Excellence | PerformanceQUALITY | Hospital: $251,206 | Professional: $43,909 | 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 | Programs of Excellence | PerformanceQUALITY | Hospital: $129,891 | Professional: $22,780 | 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 | PerformanceELITE | Hospital: $249,413 | Professional: $56,746 | 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 | Kidney | Kidney | Adult | Programs of Excellence | PerformanceELITE | Cadaveric Donor Hospital: $103,551 | Cadaveric Donor Professional: $20,483 | Living Donor Hospital: $112,071 | Living Donor Professional: $29,479 | 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 | 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 | |||||||||||||||
| Barnes-Jewish Hospital | Transplant | St Louis | MO | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | Cadaveric Donor Hospital: $204,573 | Cadaveric Donor Professional: $49,591 | Living Donor Hospital: $232,944 | Living Donor Professional: $49,973 | 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 | Blood/Marrow (Tandem) | Tandem Auto to Allo | Adult | Programs of Excellence | PerformanceQUALITY | 1st Transplant: Hospital $129,891 Professional $22,708 | 2nd Transplant: Hospital $114,366 Professional $19,981 | 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 | Multi-Organ | Multi-Organ | 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 | ||||||||||||||||
| Barnes-Jewish Hospital | Transplant | St Louis | MO | Lung | Lung | Adult | Programs of Excellence | PerformanceELITE | Single Lung Hospital: $209,508 | Single Lung Professional: $49,809 | Bilateral Lung Hospital: $257,318| Bilateral Lung Professional: $55,873 | 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 | |||||||||||||||
| Baylor Scott and White All Saints Medical Center - Fort Worth | Transplant | Fort Worth | 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 | 32.8007346 | -97.4297445 | |||||||||||||||
| Baylor Scott and White All Saints Medical Center - Fort Worth | 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 | PerformanceELITE | 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 | PerformanceSELECT | 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 | PerformanceQUALITY | 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 | PerformanceQUALITY | 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 | PerformanceSELECT | 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 | |||||||||||||||
| 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 | ||||||||||||||||||||
| 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/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 | 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 | ||||||||||||||||
| Beth Israel Deaconess Medical Center | Transplant | Boston | MA | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | 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 | Liver | Liver | Adult | Programs of Excellence | PerformanceSELECT | 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 | Multi-Organ | Multi-Organ | Adult | Member's Choice | 100% of Higher Cost Organ, Plus 50% of Lower Cost Organ | 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 | ||||||||||||||||
| 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 | ||||||||||||||||
| 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 | |||||||||||||||||||
| Brigham and Women's Hospital | Transplant | Boston | MA | Liver | Liver | Adult | Member's Choice | 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 | PerformanceQUALITY | 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 | |||||||||||||||
| Broward Health 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 | ||||||||||||||||
| Cedars-Sinai Medical Center | Transplant | Los Angeles | CA | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceSELECT | $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 | PerformanceSELECT | $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 | PerformanceSELECT | $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 | PerformanceQUALITY | $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 | Kidney | Pediatric | Member's Choice | $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 | Programs of Excellence | PerformanceSELECT | $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 | Member's Choice | $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 | ||||||||||||||||
| 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 | |||||||||||||||||||
| 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 | ||||||||||||||||||||
| 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 | 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 | 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 | |||||||||||||||
| 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 | |||||||||||||||||||
| 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 | ||||||||||||||||||||
| Children's Hospital Colorado | Transplant | Aurora | CO | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $194,226 | 35 | Transplant Case Rate Paid at 65% of Billed Charges | $5,827 | 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 | $221,972 | 35 | Transplant Case Rate Paid at 65% of Billed Charges | $5,827 | 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 | $160,930 | 31 | Transplant Case Rate Paid at 65% of Billed Charges | $5,827 | 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 | $277,466 | 30 for each Auto | Transplant Case Rate Paid at 65% of Billed Charges | $5,827 | 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 | $194,226 | 20 | $5,827 | 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 | $68,811 | 14 | $5,827 | 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 | $193,115 | 25 | $5,827 | 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 | 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 | |||||||||||||||||||
| Children's Hospital Colorado | Transplant | Aurora | CO | Heart | Heart | Pediatric | Government Rates | $157,950 | 20 | $4,212 | N/A | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Heart Assist Devices Included in Pre-Transplant or Transplant Event, as Applicable. | 60% of Billed Charges | Begins at Evaluation | Beginning One (1) Day Prior to Transplant, Ending the Day of Discharge | Ends One (1) Year from Transplant Date | 39.6890151 | -104.8269166 | ||||||||||||||||
| Children's Hospital Colorado | Transplant | Aurora | CO | Kidney | Kidney | Pediatric | Government Rates | $57,915 | 14 | $4,212 | N/A | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Heart Assist Devices Included in Pre-Transplant or Transplant Event, as Applicable. | 60% of Billed Charges | Begins at Evaluation | Beginning One (1) Day Prior to Transplant, Ending the Day of Discharge | Ends One (1) Year from Transplant Date | 39.6890151 | -104.8269166 | ||||||||||||||||
| Children's Hospital Colorado | Transplant | Aurora | CO | Liver | Liver | Pediatric | Government Rates | $168,480 | 25 | $4,212 | N/A | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Beginning One (1) Day Prior to Transplant, Ending the Day of Discharge | Ends One (1) Year from Transplant Date | 39.6890151 | -104.8269166 | |||||||||||||||||
| Children's Hospital Colorado | Transplant | Aurora | CO | Blood/Marrow (Autologous) | Autologous | Pediatric | Government Rates | $136,890 | 35 | $4,212 | N/A | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Beginning on Day of Preparative Therapy, Ending when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.6890151 | -104.8269166 | ||||||||||||||||
| Children's Hospital Colorado | Transplant | Aurora | CO | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Government Rates | $171,639 | 35 | $4,212 | N/A | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Beginning on Day of Preparative Therapy, Ending when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.6890151 | -104.8269166 | ||||||||||||||||
| Children's Hospital Colorado | Transplant | Aurora | CO | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Government Rates | $194,805 | 35 | $4,212 | N/A | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Beginning on Day of Preparative Therapy, Ending when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.6890151 | -104.8269166 | ||||||||||||||||
| Children's Hospital Colorado | Transplant | Aurora | CO | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Pediatric | Government Rates | $205,335 | 35 | $4,212 | N/A | Hospital: 65% of Billed Charges | Professional: 75% of Billed Charges | Included in Case Rate | Included in Case Rate | 60% of Billed Charges | Begins at Evaluation | Beginning on Day of Preparative Therapy, Ending when Inlier and any Applicable Outlier Days have Expired | Ends One (1) Year from Discharge | 39.6890151 | -104.8269166 | ||||||||||||||||
| 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 | Blood/Marrow (Cord Blood) | Cord Blood | Pediatric | Programs of Excellence | Hospital: $250,000 | 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 One (1) Year from Transplant Date | 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 | ||||||||||||||
| 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 | ||||||||||||||||||||
| 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 | |||||||||||||||||||
| 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 | ||||||||||||||||
| 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 | ||||||||||||||||||||
| 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 Six (6) Months from Transplant Date | 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 Six (6) Months from Transplant Date | 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 Six (6) Months from Transplant Date | 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 Six (6) Months from Transplant Date | 43.0578056 | -88.1078546 | ||||||||||||||||
| Children's Hospital of Wisconsin | Transplant | Milwaukee | WI | Lung | Lung | Pediatric | Member's Choice | $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 Six (6) Months from Transplant Date | 43.0578056 | -88.1078546 | ||||||||||||||||
| Children's Hospital of Wisconsin | Transplant | Milwaukee | WI | Heart & Lung | Heart/Lung | Pediatric | Member's Choice | $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 Six (6) Months from Transplant Date | 43.0578056 | -88.1078546 | ||||||||||||||||
| Children's Hospital of Wisconsin | Transplant | Milwaukee | WI | Heart | Heart | Pediatric | Member's Choice | $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 Six (6) Months from Transplant Date | 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 Six (6) Months from Transplant Date | 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 Six (6) Months from Transplant Date | 43.0578056 | -88.1078546 | ||||||||||||||||
| 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 | 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 | ||||||||||||||||
| 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 | |||||||||||||||||||
| 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 | Programs of Excellence | $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 | Programs of Excellence | 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 | Programs of Excellence | $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 | ||||||||||||||||
| 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 | ||||||||||||||||||||
| 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 | |||||||||||||||||||
| 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 | |||||||||||||||||||
| 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 | |||||||||||||||
| 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 | ||||||||||||||||||||
| City of Hope National Medical Center | Cancer | Duarte | CA | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 34.1578544 | -117.975176 | ||||||||||||||||||||||||||||
| 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 | |||||||||||||||
| Dana-Farber Cancer Institute | Cancer | Boston | MA | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 42.3143285 | -71.0404949 | ||||||||||||||||||||||||||||
| Duke University Hospital | Transplant | Durham | NC | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $155,000 | N/A | N/A | If Billed Charges are less than the Case Rate Payment Shall Be 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 | Lung | Lung | Pediatric | Member's Choice | Single: $260,000 | Bilateral: $270,000 | N/A | N/A | If Billed Charges are less than the Case Rate Payment Shall Be 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 | Heart | Heart | Pediatric | Member's Choice | $240,000 | N/A | N/A | If Billed Charges are less than the Case Rate Payment Shall Be 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 | If Billed Charges are less than the Case Rate Payment Shall Be 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 | If Billed Charges are less than the Case Rate Payment Shall Be 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 | ||||||||||||||||
| Duke University Hospital | Transplant | Durham | NC | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $225,000 | N/A | N/A | If Billed Charges are less than the Case Rate Payment Shall Be 90% of Billed Charges | 72% of Billed Charges | Reimbursed Pursuant to the Transplant Phase in which the Services are Provided | Reimbursed Pursuant to the Transplant Phase in which the Services are Provided | 70% of Billed Charges | If Billed Charges Exceed $382,500, Payment will be the Transplant Case Rate, Plus 73% of the Excess Charges | Begins at Evaluation | Begins on the day of Preparatory Regimen and ends Upon Discharge | Ends One (1) Year from Discharge | 36.0020232 | -79.0249944 | |||||||||||||||
| Duke University Hospital | Transplant | Durham | NC | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $270,000 | N/A | N/A | If Billed Charges are less than the Case Rate Payment Shall Be 90% of Billed Charges | 72% of Billed Charges | Reimbursed Pursuant to the Transplant Phase in which the Services are Provided | Reimbursed Pursuant to the Transplant Phase in which the Services are Provided | 70% of Billed Charges | If Billed Charges Exceed $459,000, Payment will be the Transplant Case Rate, Plus 73% of the Excess Charges | Begins at Evaluation | Begins on the day of Preparatory Regimen and ends Upon Discharge | Ends One (1) Year from Discharge | 36.0020232 | -79.0249944 | |||||||||||||||
| Duke University Hospital | Transplant | Durham | NC | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $165,000 | N/A | N/A | If Billed Charges are less than the Case Rate Payment Shall Be 90% of Billed Charges | 72% of Billed Charges | Reimbursed Pursuant to the Transplant Phase in which the Services are Provided | Reimbursed Pursuant to the Transplant Phase in which the Services are Provided | 70% of Billed Charges | If Billed Charges Exceed $280,500, Payment will be the Transplant Case Rate, Plus 73% of the Excess Charges | Begins at Evaluation | Begins on the day of Preparatory Regimen and ends Upon Discharge | Ends One (1) Year from Discharge | 36.0020232 | -79.0249944 | |||||||||||||||
| Duke University Hospital | Transplant | Durham | NC | Blood/Marrow (Cord Blood) | Cord Blood | Pediatric | Programs of Excellence | $310,000 | N/A | N/A | If Billed Charges are less than the Case Rate Payment Shall Be 90% of Billed Charges | 72% of Billed Charges | Reimbursed Pursuant to the Transplant Phase in which the Services are Provided | Reimbursed Pursuant to the Transplant Phase in which the Services are Provided | 70% of Billed Charges | If Billed Charges Exceed $527,000, Payment will be the Transplant Case Rate, Plus 73% of the Excess Charges | Begins at Evaluation | Begins on the day of Preparatory Regimen and ends Upon Discharge | Ends One (1) Year from Discharge | 36.0020232 | -79.0249944 | |||||||||||||||
| Duke University Hospital | Transplant | Durham | NC | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Pediatric | Programs of Excellence | Paid at the Applicable Transplant Rate | N/A | N/A | If Billed Charges are less than the Case Rate Payment Shall Be 90% of Billed Charges | 72% of Billed Charges | Reimbursed Pursuant to the Transplant Phase in which the Services are Provided | Reimbursed Pursuant to the Transplant Phase in which the Services are Provided | 70% of Billed Charges | If Billed Charges Exceed the Applicable Threshold for Transplant Type, Payment will be the Transplant Case Rate, Plus 73% of the Excess Charges | Begins at Evaluation | Begins on the day of Preparatory Regimen and ends Upon Discharge | Ends One (1) Year from Discharge | 36.0020232 | -79.0249944 | |||||||||||||||
| Duke University Hospital | Transplant | Durham | NC | Blood/Marrow (Tandem Auto to Allo) | Tandem Auto to Allo | Pediatric | Programs of Excellence | Paid at the Applicable Transplant Rate | N/A | N/A | If Billed Charges are less than the Case Rate Payment Shall Be 90% of Billed Charges | 72% of Billed Charges | Reimbursed Pursuant to the Transplant Phase in which the Services are Provided | Reimbursed Pursuant to the Transplant Phase in which the Services are Provided | 70% of Billed Charges | If Billed Charges Exceed the Applicable Threshold for Transplant Type, Payment will be the Transplant Case Rate, Plus 73% of the Excess Charges | Begins at Evaluation | Begins on the day of Preparatory Regimen and ends Upon Discharge | Ends One (1) Year from Discharge | 36.0020232 | -79.0249944 | |||||||||||||||
| Duke University Hospital | Transplant | Durham | NC | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | $200,000 | N/A | N/A | If Billed Charges are less than the Case Rate Payment Shall Be 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 | If Billed Charges are less than the Case Rate Payment Shall Be 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 | If Billed Charges are less than the Case Rate Payment Shall Be 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 | If Billed Charges are less than the Case Rate Payment Shall Be 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 | If Billed Charges are less than the Case Rate Payment Shall Be 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 | Adult | Programs of Excellence | PerformanceELITE | Cadaveric Donor: $180,000 | Living Donor: $190,000 | N/A | N/A | If Billed Charges are less than the Case Rate Payment Shall Be 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 | Adult | Programs of Excellence | PerformanceSELECT | Single: $250,000 | Bilateral: $265,000 | N/A | N/A | If Billed Charges are less than the Case Rate Payment Shall Be 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 | Blood/Marrow (Cord Blood) | Cord Blood | Adult | Programs of Excellence | PerformanceQUALITY | $270,000 | N/A | N/A | If Billed Charges are less than the Case Rate Payment Shall Be 90% of Billed Charges | 72% of Billed Charges | Reimbursed Pursuant to the Transplant Phase in Which the Services are Provided | Reimbursed Pursuant to the Transplant Phase in Which the Services are Provided | 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 One (1) Year from Discharge | 36.0020232 | -79.0249944 | |||||||||||||||
| Duke University Hospital | Transplant | Durham | NC | Pancreas | Pancreas | Adult | Member's Choice | $115,000 | N/A | N/A | If Billed Charges are less than the Case Rate Payment Shall Be 90% of Billed Charges | 72% of Billed Charges | Included in Case Rate | 70% of Billed Charges | If Billed Charges Exceed $195,500, 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 | Multi-Organ | Multi-Organ | Adult | Member's Choice | 80% of Billed Charges | N/A | N/A | N/A | 80% of Billed Charges | Included in Case Rate | 70% of Billed Charges | N/A | 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 | Multi-Organ | Multi-Organ | Pediatric | Member's Choice | 80% of Billed Charges | N/A | N/A | N/A | 80% of Billed Charges | Included in Case Rate | 70% of Billed Charges | N/A | 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 | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Adult | Programs of Excellence | PerformanceQUALITY | Paid at the Applicable Transplant Rate | N/A | N/A | If Billed Charges are less than the Case Rate Payment Shall Be 90% of Billed Charges | 72% of Billed Charges | Reimbursed Pursuant to the Transplant Phase in which the Services are Provided | Reimbursed Pursuant to the Transplant Phase in which the Services are Provided | 70% of Billed Charges | If Billed Charges Exceed the Applicable Threshold for Transplant Type, Payment will be the Transplant Case Rate, Plus 73% of the Excess Charges | Begins at Evaluation | Begins on the day of Preparatory Regimen and ends Upon Discharge | Ends One (1) Year from Discharge | 36.0020232 | -79.0249944 | ||||||||||||||
| Duke University Hospital | Transplant | Durham | NC | Blood/Marrow (Tandem Auto to Allo) | Tandem Auto to Allo | Adult | Programs of Excellence | PerformanceQUALITY | Paid at the Applicable Transplant Rate | N/A | N/A | If Billed Charges are less than the Case Rate Payment Shall Be 90% of Billed Charges | 72% of Billed Charges | Reimbursed Pursuant to the Transplant Phase in which the Services are Provided | Reimbursed Pursuant to the Transplant Phase in which the Services are Provided | 70% of Billed Charges | If Billed Charges Exceed the Applicable Threshold for Transplant Type, Payment will be the Transplant Case Rate, Plus 73% of the Excess Charges | Begins at Evaluation | Begins on the day of Preparatory Regimen and ends Upon Discharge | Ends One (1) Year from Discharge | 36.0020232 | -79.0249944 | ||||||||||||||
| Duke University Hospital | Cancer | Durham | NC | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 36.0018064 | -78.9551221 | ||||||||||||||||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | $191,261 | 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 | ||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceQUALITY | $223,139 | 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 | ||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceQUALITY | $151,416 | 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 | ||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Adult | Programs of Excellence | PerformanceQUALITY | $247,047 | 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 | ||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Blood/Marrow (Tandem Auto to Allo) | Tandem Auto to Allo | Adult | Programs of Excellence | PerformanceQUALITY | $283,705 | 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 | ||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | $306,019 | 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 | |||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Heart/Lung | Heart/Lung | Adult | Member's Choice | $382,524 | 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 | ||||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | Cadaveric Donor: $114,758 | Living Donor: $114,758 | Cadaveric: 10 | Living Donor: 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 | |||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Kidney/Liver | Kidney/Liver | Adult | Member's Choice | $299,644 | 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 | ||||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceELITE | $164,167 | 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 | |||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Liver | Liver | Adult | Member's Choice | Cadaeric Donor: $227,921 | Living Donor: $247,047 | 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 | ||||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Lung | Lung | Adult | Member's Choice | Single: $299,644 | Bilateral: $382,524 | 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 | ||||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Pancreas | Pancreas | Adult | Member's Choice | $111,570 | 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 | ||||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $191,261 | 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 | ||||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $223,139 | 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 | ||||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $151,416 | 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 | ||||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Pediatric | Programs of Excellence | $247,047 | 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 | ||||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Blood/Marrow (Tandem Auto to Allo) | Tandem Auto to Allo | Pediatric | Programs of Excellence | $283,705 | 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 | ||||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Heart | Heart | Pediatric | Member's Choice | $306,019 | 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 | ||||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Heart/Lung | Heart/Lung | Pediatric | Member's Choice | $382,524 | 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 | ||||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Kidney | Kidney | Pediatric | Member's Choice | Cadaveric Donor: $114,758 | Living Donor: $114,758 | Cadaveric: 10 | Living Donor: 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 | ||||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Kidney/Liver | Kidney/Liver | Pediatric | Member's Choice | $299,644 | 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 | ||||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Kidney/Pancreas | Kidney/Pancreas | Pediatric | Member's Choice | $164,167 | 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 | ||||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Liver | Liver | Pediatric | Member's Choice | Cadaeric Donor: $227,921 | Living Donor: $247,047 | 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 | ||||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Lung | Lung | Pediatric | Member's Choice | Single: $299,644 | Bilateral: $382,524 | 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 | ||||||||||||||||
| AdventHealth Orlando | Transplant | Daytona Beach | FL | Pancreas | Pancreas | Pediatric | Member's Choice | $111,570 | 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 | ||||||||||||||||
| 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/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 | ||||||||||||||||
| 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 | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | 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 | 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 | ||||||||||||||||||||
| 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 | |||||||||||||||||||
| Froedtert Memorial Lutheran Hospital | Bariatric | Milwaukee | WI | Bariatric | Bariatric | Gastric Banding: $32,293 | Gastric Bypass: $37,387 | Gastric Sleeve: $24,046 | Gastric Banding: 2 | Gastric Bypass: 3 | Gastric Sleeve: 2 | $3,878 | 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 | |||||||||||||||||||||
| Medstar Georgetown Transplant Institute | Transplant | Washington, DC | DC | Kidney | Kidney | Adult | Member's Choice | $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 | ||||||||||||||||
| Medstar Georgetown Transplant Institute | 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 | |||||||||||||||
| Medstar Georgetown Transplant Institute | 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 | |||||||||||||||
| Medstar Georgetown Transplant Institute | 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 | ||||||||||||||||
| Medstar Georgetown Transplant Institute | 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 | ||||||||||||||||
| Medstar Georgetown Transplant Institute | 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 | ||||||||||||||||
| Medstar Georgetown Transplant Institute | 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 | ||||||||||||||||
| Medstar Georgetown Transplant Institute | Transplant | Washington, DC | DC | Kidney | Kidney | Pediatric | Member's Choice | $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 | ||||||||||||||||
| Medstar Georgetown Transplant Institute | Transplant | Washington, DC | DC | Multi-Visceral | Multi-Visceral | Adult | 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 | ||||||||||||||||
| Medstar Georgetown Transplant Institute | Transplant | Washington, DC | DC | Intestine | Intestine | Adult | 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 | ||||||||||||||||
| Medstar Georgetown Transplant Institute | Transplant | Washington, DC | DC | Pancreas | Pancreas | Pediatric | 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 | ||||||||||||||||
| Medstar Georgetown Transplant Institute | Transplant | Washington, DC | DC | Heart | Heart | Adult | Member's Choice | $175,000 | 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 $300,000, 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 | 38.8937091 | -77.0846157 | ||||||||||||||||
| 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/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 | 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 | ||||||||||||||||
| 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 | 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 | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | $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 | Programs of Excellence | PerformanceQUALITY | $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 | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Adult | Programs of Excellence | PerformanceQUALITY | 1st Transplant: $85,000 | 2nd Transplant: $80,750 | 1st Transplant: 30 | 2nd Transplant: 25 | $3,000 Med/Surg | $3,500 ICU/CCU | 85% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | If Billed Charges Exceed $170,000 (1st Transplant) and $161,500 (2nd Transplant), 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 | Multi-Visceral | Multi-Visceral | 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 | Multi-Organ | Multi-Organ | Adult | Member's Choice | 100% of Higher Cost Organ, Plus 50% of Lower Cost Organ | Higher Number of the Two Organ Types | $3,000 Med/Surg | $3,500 ICU/CCU | 85% of Billed Charges | 70% of Billed Charges | Included in Case Rate | Included in Case Rate | If Billed Charges Exceed Higher Organ Threshold, Plus 50% of Lower Organ Threshold, 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 | 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 | |||||||||||||||||||
| 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 | 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 | ||||||||||||||||
| 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 | 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 | PerformanceELITE | 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 | Programs of Excellence | PerformanceQUALITY | 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 | |||||||||||||||
| 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/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 | 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 | |||||||||||||||||
| 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) | Allogeneic 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) | Allogeneic 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 | 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/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 | PerformanceSELECT | 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 | |||||||||||||||
| Indiana Blood & 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 & 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 & 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 | ||||||||||||||||
| Indiana University Health | 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 | ||||||||||||||||||||
| 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 | ||||||||||||||||
| Integris Baptist Medical Center | Transplant | Oklahoma City | OK | Heart | Heart | Adult | Programs of Excellence | PerformanceSELECT | $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 | PerformanceQUALITY | $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 | PerformanceQUALITY | 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 | |||||||||||||||
| Indiana University Health | 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 | ||||||||||||||||
| Indiana University Health | 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 | ||||||||||||||||
| Indiana University Health | 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 | ||||||||||||||||
| Indiana University Health | 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 | ||||||||||||||||
| Indiana University Health | Transplant | Indianapolis | IN | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | $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 | |||||||||||||||
| Indiana University Health | 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 | ||||||||||||||||
| Indiana University Health | 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 | ||||||||||||||||
| Indiana University Health | 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 | |||||||||||||||
| Indiana University Health | 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 | |||||||||||||||
| Indiana University Health | 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 | ||||||||||||||||
| Indiana University Health | Transplant | Indianapolis | IN | Heart | Heart | Adult | Member's Choice | $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 | ||||||||||||||||
| Indiana University Health | 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 | |||||||||||||||
| Indiana University Health | Cancer | Indianapolis | IN | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 39.7796999 | -86.2731749 | ||||||||||||||||||||||||||||
| Indiana University Health - 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 | ||||||||||||||||
| Indiana University Health - 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 | ||||||||||||||||
| Indiana University Health - 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 | ||||||||||||||||
| Indiana University Health - Riley Hospital for Children | Transplant | Indianapolis | IN | Heart | Heart | Pediatric | Programs of Excellence | $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 | ||||||||||||||||
| Indiana University Health - 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 | ||||||||||||||||
| Indiana University Health - 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 | ||||||||||||||||
| Indiana University Health - Riley Hospital for Children | Transplant | Indianapolis | IN | Multi-Visceral | Multi-Visceral | Pediatric | Programs of Excellence | 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 | ||||||||||||||||
| Jackson Memorial Hospital University of Miami School of Medicine | Transplant | Miami | FL | Heart | Heart | Adult | Member's Choice | Hospital: $272,258 | Professional: $89,590 | 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: $178,403 | Professional: $36,161 | Professional (Living Donor): $13,438 | 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 | PerformanceSELECT | Hospital: $226,393 | 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: $286,995 | Hospital Living Donor: $302,509 | Professional Cadaveric or Living Donor: $80,956 | 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: $178,403| Professional: $40,722 | Professional (Living Donor): $13,438 | 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: $286,995 | Hospital Living Donor: $302,509 | Professional Cadaveric or Living Donor: $87,961 | 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 | Heart/Kidney | Heart/Kidney | Adult | Member's Choice | Hospital: $357,212 | Professional: 80% of Billed Charges | 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 | 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 | ||||||||||||||||
| 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 at Evaluation | Beginning One (1) Day Prior to Transplant and Ending the Day of Discharge | Ends One (1) Year from Discharge | 25.7824033 | -80.2645636 | |||||||||||||||||||
| Jackson Memorial Hospital University of Miami School of Medicine (Applies to Managed Medicaid and Medicare Advantage Patients Only) | Transplant | Miami | FL | Heart | Heart | Adult | Government Rates | 120% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outlier Applicable to Services Provided | N/A | N/A | 105% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outliers Applicable to Services Provided. Codes not Listed on the Current Medicare Fee Schedule shall be Reimbursed at 60% of Billed Charges | Reimbursed in Accordance with the Medicare Cost Report (Commonly Referred to as the D-4 Report) | 60% of Billed Charges | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ends atf Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | |||||||||||||||||
| Jackson Memorial Hospital University of Miami School of Medicine (Applies to Managed Medicaid and Medicare Advantage Patients Only) | Transplant | Miami | FL | Kidney | Kidney | Adult | Government Rates | 120% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outlier Applicable to Services Provided | N/A | N/A | 105% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outliers Applicable to Services Provided. Codes not Listed on the Current Medicare Fee Schedule shall be Reimbursed at 60% of Billed Charges | Reimbursed in Accordance with the Medicare Cost Report (Commonly Referred to as the D-4 Report) | 60% of Billed Charges | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ends atf Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | |||||||||||||||||
| Jackson Memorial Hospital University of Miami School of Medicine (Applies to Managed Medicaid and Medicare Advantage Patients Only) | Transplant | Miami | FL | Liver | Liver | Adult | Government Rates | 120% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outlier Applicable to Services Provided | N/A | N/A | 105% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outliers Applicable to Services Provided. Codes not Listed on the Current Medicare Fee Schedule shall be Reimbursed at 60% of Billed Charges | Reimbursed in Accordance with the Medicare Cost Report (Commonly Referred to as the D-4 Report) | 60% of Billed Charges | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ends atf Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | |||||||||||||||||
| Jackson Memorial Hospital University of Miami School of Medicine (Applies to Managed Medicaid and Medicare Advantage Patients Only) | Transplant | Miami | FL | Liver | Liver | Pediatric | Government Rates | 120% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outlier Applicable to Services Provided | N/A | N/A | 105% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outliers Applicable to Services Provided. Codes not Listed on the Current Medicare Fee Schedule shall be Reimbursed at 60% of Billed Charges | Reimbursed in Accordance with the Medicare Cost Report (Commonly Referred to as the D-4 Report) | 60% of Billed Charges | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ends atf Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | |||||||||||||||||
| Jackson Memorial Hospital University of Miami School of Medicine (Applies to Managed Medicaid and Medicare Advantage Patients Only) | Transplant | Miami | FL | Lung | Lung | Adult | Government Rates | 120% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outlier Applicable to Services Provided | N/A | N/A | 105% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outliers Applicable to Services Provided. Codes not Listed on the Current Medicare Fee Schedule shall be Reimbursed at 60% of Billed Charges | Reimbursed in Accordance with the Medicare Cost Report (Commonly Referred to as the D-4 Report) | 60% of Billed Charges | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ends atf Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | |||||||||||||||||
| Jackson Memorial Hospital University of Miami School of Medicine (Applies to Managed Medicaid and Medicare Advantage Patients Only) | Transplant | Miami | FL | Lung | Lung | Pediatric | Government Rates | 120% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outlier Applicable to Services Provided | N/A | N/A | 105% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outliers Applicable to Services Provided. Codes not Listed on the Current Medicare Fee Schedule shall be Reimbursed at 60% of Billed Charges | Reimbursed in Accordance with the Medicare Cost Report (Commonly Referred to as the D-4 Report) | 60% of Billed Charges | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ends atf Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | |||||||||||||||||
| Jackson Memorial Hospital University of Miami School of Medicine (Applies to Managed Medicaid and Medicare Advantage Patients Only) | Transplant | Miami | FL | Intestine | Intestine | Adult | Government Rates | 120% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outlier Applicable to Services Provided | N/A | N/A | 105% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outliers Applicable to Services Provided. Codes not Listed on the Current Medicare Fee Schedule shall be Reimbursed at 60% of Billed Charges | Reimbursed in Accordance with the Medicare Cost Report (Commonly Referred to as the D-4 Report) | 60% of Billed Charges | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ends atf Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | |||||||||||||||||
| Jackson Memorial Hospital University of Miami School of Medicine (Applies to Managed Medicaid and Medicare Advantage Patients Only) | Transplant | Miami | FL | Multi-Visceral | Multi-Visceral | Adult | Government Rates | 120% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outlier Applicable to Services Provided | N/A | N/A | 105% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outliers Applicable to Services Provided. Codes not Listed on the Current Medicare Fee Schedule shall be Reimbursed at 60% of Billed Charges | Reimbursed in Accordance with the Medicare Cost Report (Commonly Referred to as the D-4 Report) | 60% of Billed Charges | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ends atf Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | |||||||||||||||||
| Jackson Memorial Hospital University of Miami School of Medicine (Applies to Managed Medicaid and Medicare Advantage Patients Only) | Transplant | Miami | FL | Heart/Lung | Heart/Lung | Adult | Government Rates | 120% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outlier Applicable to Services Provided | N/A | N/A | 105% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outliers Applicable to Services Provided. Codes not Listed on the Current Medicare Fee Schedule shall be Reimbursed at 60% of Billed Charges | Reimbursed in Accordance with the Medicare Cost Report (Commonly Referred to as the D-4 Report) | 60% of Billed Charges | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ends atf Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | |||||||||||||||||
| Jackson Memorial Hospital University of Miami School of Medicine (Applies to Managed Medicaid and Medicare Advantage Patients Only) | Transplant | Miami | FL | Kidney/Pancreas | Kidney/Pancreas | Adult | Government Rates | 120% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outlier Applicable to Services Provided | N/A | N/A | 105% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outliers Applicable to Services Provided. Codes not Listed on the Current Medicare Fee Schedule shall be Reimbursed at 60% of Billed Charges | Reimbursed in Accordance with the Medicare Cost Report (Commonly Referred to as the D-4 Report) | 60% of Billed Charges | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ends atf Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | |||||||||||||||||
| Jackson Memorial Hospital University of Miami School of Medicine (Applies to Managed Medicaid and Medicare Advantage Patients Only) | Transplant | Miami | FL | Multi-Organ | Multi-Organ | Adult | Government Rates | 120% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outlier Applicable to Services Provided | N/A | N/A | 105% of Medicare Allowable Amounts Current on the Date Services were Rendered Including Outliers Applicable to Services Provided. Codes not Listed on the Current Medicare Fee Schedule shall be Reimbursed at 60% of Billed Charges | Reimbursed in Accordance with the Medicare Cost Report (Commonly Referred to as the D-4 Report) | 60% of Billed Charges | N/A | Begins at Evaluation | Beginning One (1) Day Prior to Transplant and Ends atf Discharge | Ends One (1) Year from Discharge | 25.7825453 | -80.2994984 | |||||||||||||||||
| 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 | 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 | ||||||||||||||||
| 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 | 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 | Kidney | 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 | 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 | 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 | 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 | 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 | ||||||||||||||||||||
| Johns Hopkins Hospital | Cancer | Baltimore | MD | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 39.2846853 | -76.6907077 | ||||||||||||||||||||||||||||
| Johns Hopkins Hospital (Applies to Medicaid Patients in the State of MD and Medicare Advantage Patients) | Transplant | Baltimore | MD | Kidney | Kidney | Adult | Government Rates | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | N/A | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | 100% of HSCRC Rates Less Applicable discount for Medicare Advantage or Maryland Medicaid MCOs; Provided, However, in the Event that the HSCRC Determines that Kidney Organ Acquisition for Medicare Advantage Members will be Reimbursed by the Centers for Medicare and Medicaid Services (CMS) under the Original Medicare Fee-for-Service Program as Provided under the 21st Century Cures Act and other Applicable Statutes and Regulations, this Provision shall Automatically be Deemed to be Amended to Reflect this Alternate Reimbursement. | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | N/A | Begins at Notification | Begins One Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 1 Year Later | 39.2848183 | -76.6905365 | ||||||||||||||||||
| Johns Hopkins Hospital (Applies to Medicaid Patients in the State of MD and Medicare Advantage Patients) | Transplant | Baltimore | MD | Liver | Liver | Adult | Government Rates | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | N/A | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | 100% of HSCRC Rates Less Applicable discount for Medicare Advantage or Maryland Medicaid MCOs. | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | N/A | Begins at Notification | Begins One Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 1 Year Later | 39.2848183 | -76.6905365 | ||||||||||||||||||
| Johns Hopkins Hospital (Applies to Medicaid Patients in the State of MD and Medicare Advantage Patients) | Transplant | Baltimore | MD | Pancreas | Pancreas | Adult | Government Rates | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | N/A | Hosptial: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | 100% of HSCRC Rates Less Applicable discount for Medicare Advantage or Maryland Medicaid MCOs. | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | N/A | Begins at Notification | Begins One Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 1 Year Later | 39.2848183 | -76.6905365 | ||||||||||||||||||
| Johns Hopkins Hospital (Applies to Medicaid Patients in the State of MD and Medicare Advantage Patients) | Transplant | Baltimore | MD | Kidney/Pancreas | Kidney/Pancreas | Adult | Government Rates | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | N/A | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | 100% of HSCRC Rates Less Applicable discount for Medicare Advantage or Maryland Medicaid MCOs; Provided, However, in the Event that the HSCRC Determines that Kidney Organ Acquisition for Medicare Advantage Members will be Reimbursed by the Centers for Medicare and Medicaid Services (CMS) under the Original Medicare Fee-for-Service Program as Provided under the 21st Century Cures Act and other Applicable Statutes and Regulations, this Provision shall Automatically be Deemed to be Amended to Reflect this Alternate Reimbursement. | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | N/A | Begins at Notification | Begins One Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 1 Year Later | 39.2848183 | -76.6905365 | ||||||||||||||||||
| Johns Hopkins Hospital (Applies to Medicaid Patients in the State of MD and Medicare Advantage Patients) | Transplant | Baltimore | MD | Heart | Heart | Adult | Government Rates | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | N/A | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | 100% of HSCRC Rates Less Applicable discount for Medicare Advantage or Maryland Medicaid MCOs. | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | N/A | Begins at Notification | Begins One Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 1 Year Later | 39.2848183 | -76.6905365 | ||||||||||||||||||
| Johns Hopkins Hospital (Applies to Medicaid Patients in the State of MD and Medicare Advantage Patients) | Transplant | Baltimore | MD | Lung | Lung | Adult | Government Rates | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | N/A | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | 100% of HSCRC Rates Less Applicable discount for Medicare Advantage or Maryland Medicaid MCOs. | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | N/A | Begins at Notification | Begins One Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 1 Year Later | 39.2848183 | -76.6905365 | ||||||||||||||||||
| Johns Hopkins Hospital (Applies to Medicaid Patients in the State of MD and Medicare Advantage Patients) | Transplant | Baltimore | MD | Blood/Marrow (Autologous) | Autologous | Adult | Government Rates | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | N/A | N/A | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | N/A | Begins at Notification | Begins on the First Day of Preparative Regimen and Ends Sixty Days Later | Begins at Discharge and Ends 1 Year Later | 39.2848183 | -76.6905365 | |||||||||||||||||
| Johns Hopkins Hospital (Applies to Medicaid Patients in the State of MD and Medicare Advantage Patients) | Transplant | Baltimore | MD | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Government Rates | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | N/A | N/A | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | N/A | Begins at Notification | Begins on the First Day of Preparative Regimen and Ends Sixty Days Later | Begins at Discharge and Ends 1 Year Later | 39.2848183 | -76.6905365 | |||||||||||||||||
| Johns Hopkins Hospital (Applies to Medicaid Patients in the State of MD and Medicare Advantage Patients) | Transplant | Baltimore | MD | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Related | Adult | Government Rates | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | N/A | N/A | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | N/A | Begins at Notification | Begins on the First Day of Preparative Regimen and Ends Sixty Days Later | Begins at Discharge and Ends 1 Year Later | 39.2848183 | -76.6905365 | |||||||||||||||||
| Johns Hopkins Hospital (Applies to Medicaid Patients in the State of MD and Medicare Advantage Patients) | Transplant | Baltimore | MD | Kidney | Kidney | Pediatric | Government Rates | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | N/A | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | 100% of HSCRC Rates Less Applicable discount for Medicare Advantage or Maryland Medicaid MCOs; Provided, However, in the Event that the HSCRC Determines that Kidney Organ Acquisition for Medicare Advantage Members will be Reimbursed by the Centers for Medicare and Medicaid Services (CMS) under the Original Medicare Fee-for-Service Program as Provided under the 21st Century Cures Act and other Applicable Statutes and Regulations, this Provision shall Automatically be Deemed to be Amended to Reflect this Alternate Reimbursement. | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | N/A | Begins at Notification | Begins One Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 1 Year Later | 39.2848183 | -76.6905365 | ||||||||||||||||||
| Johns Hopkins Hospital (Applies to Medicaid Patients in the State of MD and Medicare Advantage Patients) | Transplant | Baltimore | MD | Liver | Liver | Pediatric | Government Rates | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | N/A | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | 100% of HSCRC Rates Less Applicable discount for Medicare Advantage or Maryland Medicaid MCOs. | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | N/A | Begins at Notification | Begins One Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 1 Year Later | 39.2848183 | -76.6905365 | ||||||||||||||||||
| Johns Hopkins Hospital (Applies to Medicaid Patients in the State of MD and Medicare Advantage Patients) | Transplant | Baltimore | MD | Pancreas | Pancreas | Pediatric | Government Rates | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | N/A | Hosptial: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | 100% of HSCRC Rates Less Applicable discount for Medicare Advantage or Maryland Medicaid MCOs. | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | N/A | Begins at Notification | Begins One Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 1 Year Later | 39.2848183 | -76.6905365 | ||||||||||||||||||
| Johns Hopkins Hospital (Applies to Medicaid Patients in the State of MD and Medicare Advantage Patients) | Transplant | Baltimore | MD | Kidney/Pancreas | Kidney/Pancreas | Pediatric | Government Rates | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | N/A | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | 100% of HSCRC Rates Less Applicable discount for Medicare Advantage or Maryland Medicaid MCOs; Provided, However, in the Event that the HSCRC Determines that Kidney Organ Acquisition for Medicare Advantage Members will be Reimbursed by the Centers for Medicare and Medicaid Services (CMS) under the Original Medicare Fee-for-Service Program as Provided under the 21st Century Cures Act and other Applicable Statutes and Regulations, this Provision shall Automatically be Deemed to be Amended to Reflect this Alternate Reimbursement. | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | N/A | Begins at Notification | Begins One Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 1 Year Later | 39.2848183 | -76.6905365 | ||||||||||||||||||
| Johns Hopkins Hospital (Applies to Medicaid Patients in the State of MD and Medicare Advantage Patients) | Transplant | Baltimore | MD | Heart | Heart | Pediatric | Government Rates | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | N/A | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | 100% of HSCRC Rates Less Applicable discount for Medicare Advantage or Maryland Medicaid MCOs. | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | N/A | Begins at Notification | Begins One Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 1 Year Later | 39.2848183 | -76.6905365 | ||||||||||||||||||
| Johns Hopkins Hospital (Applies to Medicaid Patients in the State of MD and Medicare Advantage Patients) | Transplant | Baltimore | MD | Lung | Lung | Pediatric | Government Rates | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | N/A | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | 100% of HSCRC Rates Less Applicable discount for Medicare Advantage or Maryland Medicaid MCOs. | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | N/A | Begins at Notification | Begins One Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 1 Year Later | 39.2848183 | -76.6905365 | ||||||||||||||||||
| Johns Hopkins Hospital (Applies to Medicaid Patients in the State of MD and Medicare Advantage Patients) | Transplant | Baltimore | MD | Blood/Marrow (Autologous) | Autologous | Pediatric | Government Rates | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | N/A | N/A | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | N/A | Begins at Notification | Begins on the First Day of Preparative Regimen and Ends Sixty Days Later | Begins at Discharge and Ends 1 Year Later | 39.2848183 | -76.6905365 | |||||||||||||||||
| Johns Hopkins Hospital (Applies to Medicaid Patients in the State of MD and Medicare Advantage Patients) | Transplant | Baltimore | MD | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Government Rates | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | N/A | N/A | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | N/A | Begins at Notification | Begins on the First Day of Preparative Regimen and Ends Sixty Days Later | Begins at Discharge and Ends 1 Year Later | 39.2848183 | -76.6905365 | |||||||||||||||||
| Johns Hopkins Hospital (Applies to Medicaid Patients in the State of MD and Medicare Advantage Patients) | Transplant | Baltimore | MD | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Related | Pediatric | Government Rates | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | N/A | N/A | Hospital: 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | Professional: 80% of Billed Charges | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | 100% of HSCRC Rates Less Applicable Discount for Medicare Advantage or Maryland Medicaid MCOs | N/A | Begins at Notification | Begins on the First Day of Preparative Regimen and Ends Sixty Days Later | Begins at Discharge and Ends 1 Year Later | 39.2848183 | -76.6905365 | |||||||||||||||||
| Karmanos Cancer Center | 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 Center | 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 Center | 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 | |||||||||||||||
| 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 from First Day of Ablative Therapy Through the Day of last Infusion 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 from First Day of Ablative Therapy Through the Day of last Infusion 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 from First Day of Ablative Therapy Through the Day of last Infusion 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 | PerformanceSELECT | $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 | Programs of Excellence | PerformanceSELECT | 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 | Programs of Excellence | PerformanceQUALITY | 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 | |||||||||||||||
| Keck Hospital of USC | Transplant | Los Angeles | CA | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Adult | Programs of Excellence | PerformanceSELECT | 1st Transplant: 120,750 | 2nd Transplant: 97,750 | 30 | In its entirety from First Day of Ablative Therapy Through the Day of last Infusion Occurs Completely on an Outpatient basis | 45% of Billed Charges | 90% of Billed Charges | 45% of Billed Charges | Reinbursed at Invoice Cost | 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 | Multi-Organ | Multi-Organ | Adult | Member's Choice | 100% of Higher Cost Organ, Plus 50% of Lower Cost Organ | Equal to Number of Days of Higher Cost Organ | 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 | Pancreas | Pancreas | Adult | Member's Choice | $97,750 | 18 | 45% of Billed Charges | 90% of Billed Charges | 45% of Billed Charges | 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 | 34.0207305 | -118.6919155 | |||||||||||||||||
| Keck Hospital of USC (Applies to Medicare Advantage Only) | 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 (Applies to Medicare Advantage Only) | 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 (Applies to Medicare Advantage Only) | 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 (Applies to Medicare Advantage Only) | 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 (Applies to Medicare Advantage Only) | 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 (Applies to Medicare Advantage Only) | 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 (Applies to Medicare Advantage Only) | 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 | ||||||||||||||||
| Keck Hospital of USC (Applies to Medicare Advantage Only) | Transplant | Los Angeles | CA | Pancreas | 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 | ||||||||||||||||
| 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/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 | 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 | 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 | |||||||||||||||
| 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 | ||||||||||||||||
| Lucile Salter Packard Children's Hospital at Stanford | Transplant | Palo Alto | CA | Multi-Organ | Multi-Organ | Pediatric | Member's Choice | 100% of Higher Cost Organ, Plus 50% of Lower Cost Organ | N/A | N/A | 70% of Billed Charges | 60% of Billed Charges | Included in Case Rate | Reimbursed at Invoice Cost | Charges that Exceed the Associated Organ Threshold 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 | 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 | ||||||||||||||||||||
| 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 | PerformanceELITE | 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 | PerformanceSELECT | 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 | |||||||||||||||
| Mayo Clinic Florida | Transplant | Jacksonville | FL | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | 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 | Programs of Excellence | PerformanceQUALITY | $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 | Programs of Excellence | PerformanceQUALITY | $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 | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Member's Choice | PerformanceQUALITY | 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 | Pediatric | Member's Choice | PerformanceQUALITY | $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 | Pediatric | Member's Choice | PerformanceQUALITY | $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 | PerformanceSELECT | 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 | 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 | Liver | Liver | Adult | Programs of Excellence | PerformanceELITE | 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 | ||||||||||||||||
| Mayo Clinic Florida | Transplant | Jacksonville | FL | Multi-Organ | Multi-Organ | Adult | Member's Choice | 100% of Higher Cost Organ, Plus 50% of Lower Cost Organ | 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 | 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 | ||||||||||||||||||||
| Mayo Clinic Florida | Cancer | Jacksonville | FL | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 30.344915 | -81.8235326 | ||||||||||||||||||||||||||||
| 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 | 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 Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceELITE | Matched: $118000 | Mismatched: $138,000 | 100 | 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 | Pancreas | Pancreas | Adult | Member's Choice | $69,000 | 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 | Multi-Organ | Multi-Organ | Adult | Member's Choice | 100% of the Higher Cost Organ + 50% of the Lower Cost Organ | 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 | 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 | |||||||||||||||||||
| Mayo Clinic Hospital Arizona | Cancer | Phoenix | AZ | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 33.6050976 | -112.4059148 | ||||||||||||||||||||||||||||
| 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 | |||||||||||||||
| 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 | ||||||||||||||||||||
| 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 | Liver | Liver | Adult | Member's Choice | 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 | 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 | Blood/Marrow (Cord Blood) | Cord Blood | Adult | Programs of Excellence | PerformanceSELECT | $196,100 | N/A | N/A | Lesser of 95% | 75% of Billed Charges | Included in Case Rate | 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 | 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 | Pancreas | Pancreas | Adult | Member's Choice | $110,000 | 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 ($180,200) | 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 | Lung | Lung | Adult | Member's Choice | $180,000 | 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 ($320,000) | 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 | 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 | |||||||||||||||||||
| 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 | ||||||||||||||||||||
| Medical University of South Carolina | Cancer | Columbia | SC | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 34.037489 | -81.0077761 | ||||||||||||||||||||||||||||
| 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 | ||||||||||||||
| 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 | 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 | ||||||||||||||||||||
| Memorial Sloan Kettering Cancer Center | Cancer | New York | NY | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 40.697403 | -74.1201058 | ||||||||||||||||||||||||||||
| 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 | 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 | ||||||||||||||||
| Methodist Dallas Medical Center | Transplant | Dallas | TX | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | 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/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceQUALITY | $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 University Hospital | Transplant | Memphis | TN | Kidney | Kidney | Adult | Member's Choice | 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 | 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 | ||||||||||||||||
| Methodist University Hospital | Transplant | Memphis | TN | Kidney/Pancreas | Kidney/Pancreas | Adult | Programs of Excellence | PerformanceQUALITY | $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 | |||||||||||||||
| 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 | |||||||||||||||
| Moffitt Cancer Center | Cancer | Tampa | FL | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 27.9944112 | -82.5947063 | ||||||||||||||||||||||||||||
| 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 | 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 | 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 | 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 | Programs of Excellence | 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 | Programs of Excellence | $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 | Programs of Excellence | 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 | 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 | PerformanceQUALITY | $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 | 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 | ||||||||||||||||||||
| Mount Sinai Medical Center | Transplant | New York | NY | Kidney/Pancreas | Kidney/Pancreas | Pediatric | 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 | Pancreas | Pancreas | Pediatric | 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 | ||||||||||||||||
| 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 | |||||||||||||||
| 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 | ||||||||||||||||||||
| Northwest Marrow Transplant Program (Oregon Health & Science University) | Transplant | Portland | OR | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $165,166 | 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 $300,602, 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 | $223,505 | 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 $406,779, 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 | $238,940 | 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 $434,871, 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: $165,166 | 2nd Infusion: $129,802 | 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 $300,602 for the 1st Infusion and $236,272 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 (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceSELECT | $139,840 | 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 $254,509, 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 | $156,908 | 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 $285,573, 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 | $144,289 | 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 $262,606, 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: $139,840| 2nd Infusion: $109,914 | 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 $254,509 for the 1st Infusion and $200,509 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 (Cord Blood) | Cord Blood | Adult | Programs of Excellence | PerformanceSELECT | 65% of Billed Charges | N/A | 65% of Billed Charges | N/A | N/A | 70% of Billed Charges | Included in Case Rate | N/A | N/A | 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 (Cord Blood) | Cord Blood | Pediatric | Programs of Excellence | 65% of Billed Charges | N/A | 65% of Billed Charges | N/A | N/A | 70% of Billed Charges | Included in Case Rate | N/A | N/A | Begins at Evaluation | Begins on the Day of Ablative Therapy and Ends at Discharge | Ends One (1) Year from Discharge | 45.5426915 | -122.7245379 | |||||||||||||||
| Northwestern Memorial Hospital | Transplant | Chicago | IL | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | $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 | Member's Choice | $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 | Member's Choice | $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 | Member's Choice | 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 | Member's Choice | $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 | PerformanceSELECT | $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 | Member's Choice | 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 | |||||||||||||||
| Northwestern Memorial Hospital | Transplant | Chicago | IL | Blood/Marrow (Cord Blood) | Cord Blood | Adult | Member's Choice | $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 | Pancreas | Pancreas | Adult | Member's Choice | $85,000 | 16 | $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 | Cancer | Chicago | IL | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 41.8336474 | -87.8723887 | ||||||||||||||||||||||||||||
| 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 | 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 (Temporary Pause on Referrals) | 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 | ||||||||||||||||
| 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/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 | PerformanceSELECT | $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 $355,0580, 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 | Pancreas | Pancreas | Adult | Member's Choice | $114,270 | N/A | N/A | 80% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 75% of Billed Charges | If Billed Charges Exceed $182,832, 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 | Multi-Organ | Multi-Organ | Adult | Member's Choice | 100% of Higher Cost Organ, Plus 50% of Lower Cost Organ | N/A | N/A | 80% of Billed Charges | 80% of Billed Charges | Included in Case Rate | 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 | 29.958954 | -90.185577 | ||||||||||||||||
| 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 | |||||||||||||||||||
| 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 | ||||||||||||||||||||
| 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 | Member's Choice | $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 | Heart | Heart | Adult | Programs of Excellence | PerformanceSELECT | $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 | Liver | Liver | Adult | Programs of Excellence | PerformanceELITE | $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 | |||||||||||||||
| Ohio State University Medical Center | Transplant | Columbus | OH | Heart/Lung | Heart/Lung | Adult | Member's Choice | $600,000 | 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 | ||||||||||||||||
| Ohio State University Medical Center | Transplant | Columbus | OH | Multi-Organ | Multi-Organ | Adult | Member's Choice | 100% of Higher Cost Organ, Plus 50% of Lower Cost Organ | Equal to Number of Days of Higher Cost Organ | $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 | 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 | |||||||||||||||||||
| 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 | Member's Choice | 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 | ||||||||||||||||
| 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 | Programs of Excellence | PerformanceELITE | $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 | 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 | ||||||||||||||||||||
| 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 | |||||||||||||||||||
| 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 | ||||||||||||||||||||
| Oregon Health & Science University | Cancer | Portland | OR | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 45.5426915 | -122.7245379 | ||||||||||||||||||||||||||||
| Oregon Health & Science University (Applies to OEBB/PEBB Only) | 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 (Applies to OEBB/PEBB Only) | 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 (Applies to OEBB/PEBB Only) | 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 (Applies to OEBB/PEBB Only) | 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 (Applies to OEBB/PEBB Only) | 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 (Applies to OEBB/PEBB Only) | 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 (Applies to OEBB/PEBB Only) | 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 (Applies to OEBB/PEBB Only) | 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 (Applies to OEBB/PEBB Only) | 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 (Applies to OEBB/PEBB Only) | 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 (Applies to OEBB/PEBB Only) | 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 (Applies to OEBB/PEBB Only) | 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 | |||||||||||||||
| 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 | ||||||||||||||||
| 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 | |||||||||||||||||||
| Phoenix Children's Hospital | Transplant | Phoenix | AZ | Blood/Marrow (Tandem) | Tandem Auto-to-Auto | Pediatric | Programs of Excellence | 1st Transplant: $150,000 | 2nd Transplant: $140,000 | 25 | $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 for the 1st Transplant and $260,000 for the 2nd Transplant Shall be Reimbursed at 65%, in Addition to the Case Rate and any Applicable Per Diems | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 33.6050976 | -112.4059148 | ||||||||||||||||
| Phoenix Children's Hospital | Transplant | Phoenix | AZ | Blood/Marrow (Tandem Auto to Allo) | Tandem Auto to Allo | Pediatric | Programs of Excellence | 1st Transplant: $150,000 | 2nd Transplant: $185,000 | 25 | $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 for the 1st Transplant and $260,000 for the 2nd Transplant Shall be Reimbursed at 65%, in Addition to the Case Rate and any Applicable Per Diems | Begins at Evaluation | Begins on the Day of Admission and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 33.6050976 | -112.4059148 | ||||||||||||||||
| Centura 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 | ||||||||||||||||
| Centura 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 | ||||||||||||||||
| Centura 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 | ||||||||||||||||
| Providence 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 | ||||||||||||||||
| 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 | Blood/Marrow (Tandem) | Tandem Auto-to-Auto | Pediatric | Programs of Excellence | 1st Transplant: $120,000 | 2nd & 3rd Transplant: 80% of 1st Transplant Case Rate | 30 for Each Transplant | 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 (1) Year 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 | ||||||||||||||||
| Rady Children's Hospital and Health Center | Transplant | Encinitas | CA | Blood/Marrow (Cord Blood) | Cord Blood | Pediatric | Programs of Excellence | $240,000 | 40 | 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 (1) Year from Discharge | 33.0441071 | -117.2892539 | ||||||||||||||||
| 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/Pancreas | Kidney/Pancreas | 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 | 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 | ||||||||||||||||
| 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 | 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 | 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 | 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 | Multi-Organ | Multi-Organ | Adult | Member's Choice | 100% of Higher Cost Organ, Plus 50% of Lower Cost Organ | 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 | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | 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 | Pediatric | Programs of Excellence | $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 | Pediatric | Programs of Excellence | $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 | Pediatric | 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 | Kidney | Kidney | Pediatric | Member's Choice | 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 | Liver | Liver | Pediatric | Member's Choice | 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 | Multi-Organ | Multi-Organ | Pediatric | Member's Choice | 100% of Higher Cost Organ, Plus 50% of Lower Cost Organ | 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) | 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 | ||||||||||||||||||||
| Rochester Methodist Hospital (Mayo Clinic) | Cancer | Rochester | MN | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 43.9959661 | -92.5513833 | ||||||||||||||||||||||||||||
| 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 | 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 | ||||||||||||||||
| 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 | Programs of Excellence | PerformanceQUALITY | $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 | |||||||||||||||
| Scripps Green Hospital | Transplant | San Diego | CA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | $125,000 | N/A | 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 | 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 | 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 | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Adult | Member's Choice | 1st Transplant: $80,000 | 2nd Transplant: $60,000 | N/A | 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 One (1) Year 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 | ||||||||||||||||
| 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 | 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 | 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 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 (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 (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 | 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 | ||||||||||||||||||||
| Seattle Cancer Care Alliance | Cancer | Seattle | WA | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 47.613007 | -122.4122753 | ||||||||||||||||||||||||||||
| Seattle Children's Hospital | Transplant | Seattle | WA | Heart | Heart | Pediatric | Programs of Excellence | Hospital: $221,319 | Professional: $54,948 | 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 | Kidney | Kidney | Pediatric | Programs of Excellence | Cadaveric Donor: Hospital: $93,122 | Professional: $23,388 | Living Donor: Hospital: $94,492| Professional: $23,525 | 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: $215,471 | Cadaveric Donor Professional: $52,125 | Living Donor Hospital: $215,471 | Living Donor Professional: $53,132 | 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 | ||||||||||||||||
| Spectrum Health | Transplant | Grand Rapids | MI | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | $168,925 | 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 | $197,079 | 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 | $112,617 | 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 | Member's Choice | $362,200 | 30 | 72% of Billed Charges | 80% 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 | $344,606 | 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 | $344,606 | 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 | $146,739 | 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 | ||||||||||||||||
| Spectrum Health | Transplant | Grand Rapids | MI | Lung | Lung | Adult | Programs of Excellence | PerformanceELITE | Lung Only: $298,000 | Lung with ECMO: $580,000 | Lung Only: 30 | Lung with ECMO: 40 | 72% of Billed Charges | 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 | |||||||||||||||
| 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/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 | |||||||||||||||||
| 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 | ||||||||||||||||
| 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 | |||||||||||||||
| St Joseph's Hospital and Medical Center | Transplant | Phoenix | AZ | Multi-Organ | Multi-Organ | Adult | Member's Choice | 100% of Higher Cost Organ + 70% of Lower Cost Organ | 20 | Hospital: $4,500 | Professional: $950 | Hospital Inpatient: $4,500 Per Diem | Hospital Outpatient: 70% of Billed Charges | Professional Inpatient: $950 Per Diem | Professional Outpatient: 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 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 | ||||||||||||||||
| St Jude Children's Research Hospital | Cancer | Memphis | TN | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 35.129105 | -90.1112123 | ||||||||||||||||||||||||||||
| St Louis Children's Hospital | Transplant | St Louis | MO | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Member's Choice | $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 | Member's Choice | $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 | Member's Choice | $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 | ||||||||||||||||
| 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 | PerformanceELITE | $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 | Programs of Excellence | PerformanceQUALITY | 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 | San Francisco | CA | Multi-Organ | Multi-Organ | Adult | Member's Choice | 100% of Higher Cost Organ, Plus 50% of Lower Cost Organ | Based on Organ with Highest Allowable Days | $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 | ||||||||||||||||
| 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 | ||||||||||||||||||||
| Stanford Health Care | Transplant | San Francisco | CA | Blood/Marrow (Autologous) | Autologous | Adult | Government Rates | 125% of Region 9, Santa Clara County Locality Fee Schedule | N/A | N/A | N/A | N/A | 125% of Region 9, Santa Clara County Locality Fee Schedule | 100% of Invoice Cost | N/A | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 365 Days Later | 37.7576948 | -122.4727051 | |||||||||||||||
| Stanford Health Care | Transplant | San Francisco | CA | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Government Rates | 125% of Region 9, Santa Clara County Locality Fee Schedule | N/A | N/A | N/A | N/A | 125% of Region 9, Santa Clara County Locality Fee Schedule | 100% of Invoice Cost | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 365 Days Later | 37.7576948 | -122.4727051 | |||||||||||||||
| Stanford Health Care | Transplant | San Francisco | CA | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Government Rates | 125% of Region 9, Santa Clara County Locality Fee Schedule | N/A | N/A | N/A | N/A | 125% of Region 9, Santa Clara County Locality Fee Schedule | 100% of Invoice Cost | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 365 Days Later | 37.7576948 | -122.4727051 | |||||||||||||||
| Stanford Health Care | Transplant | San Francisco | CA | Heart | Heart | Adult | Government Rates | 125% of Region 9, Santa Clara County Locality Fee Schedule | N/A | N/A | N/A | 125% of Region 9, Santa Clara County Locality Fee Schedule | 100% of Invoice Cost | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 365 Days Later | 37.7576948 | -122.4727051 | ||||||||||||||||
| Stanford Health Care | Transplant | San Francisco | CA | Heart/Lung | Heart/Lung | Adult | Government Rates | 125% of Region 9, Santa Clara County Locality Fee Schedule | N/A | N/A | N/A | 125% of Region 9, Santa Clara County Locality Fee Schedule | 100% of Invoice Cost | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 365 Days Later | 37.7576948 | -122.4727051 | ||||||||||||||||
| Stanford Health Care | Transplant | San Francisco | CA | Kidney | Kidney | Adult | Government Rates | 125% of Region 9, Santa Clara County Locality Fee Schedule | N/A | N/A | N/A | 125% of Region 9, Santa Clara County Locality Fee Schedule | 100% of Invoice Cost | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 365 Days Later | 37.7576948 | -122.4727051 | ||||||||||||||||
| Stanford Health Care | Transplant | San Francisco | CA | Kidney/Pancreas | Kidney/Pancreas | Adult | Government Rates | 125% of Region 9, Santa Clara County Locality Fee Schedule | N/A | N/A | N/A | 125% of Region 9, Santa Clara County Locality Fee Schedule | 100% of Invoice Cost | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 365 Days Later | 37.7576948 | -122.4727051 | ||||||||||||||||
| Stanford Health Care | Transplant | San Francisco | CA | Liver | Liver | Adult | Government Rates | 125% of Region 9, Santa Clara County Locality Fee Schedule | N/A | N/A | N/A | 125% of Region 9, Santa Clara County Locality Fee Schedule | 100% of Invoice Cost | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 365 Days Later | 37.7576948 | -122.4727051 | ||||||||||||||||
| Stanford Health Care | Transplant | San Francisco | CA | Lung | Lung | Adult | Government Rates | 125% of Region 9, Santa Clara County Locality Fee Schedule | N/A | N/A | N/A | 125% of Region 9, Santa Clara County Locality Fee Schedule | 100% of Invoice Cost | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 365 Days Later | 37.7576948 | -122.4727051 | ||||||||||||||||
| Stanford Health Care | Transplant | San Francisco | CA | Pancreas | Pancreas | Adult | Government Rates | 125% of Region 9, Santa Clara County Locality Fee Schedule | N/A | N/A | N/A | 125% of Region 9, Santa Clara County Locality Fee Schedule | 100% of Invoice Cost | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 365 Days Later | 37.7576948 | -122.4727051 | ||||||||||||||||
| Strong Memorial Hospital, University of Rochester Medical Center | Transplant | Rochester | NY | Heart | Heart | Adult | Member's Choice | $257,300 | 20 | Days 21-40: $5,770 Med/Surg $5,770 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, University of Rochester Medical Center | Transplant | Rochester | NY | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | $187,500 | 20 | Days 21-40: $5,770 Med/Surg $5,770 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, University of Rochester Medical Center | Transplant | Rochester | NY | Pancreas | Pancreas | Adult | Member's Choice | $134,200 | 20 | Days 21-40: $5,770 Med/Surg $5,770 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, University of Rochester Medical Center | Transplant | Rochester | NY | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Programs of Excellence | $237,900 | 40 | Days 41-60: $5,870 Med/Surg $5,870 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, University of Rochester Medical Center | Transplant | Rochester | NY | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Pediatric | Programs of Excellence | $281,800 | 40 | Days 41-60: $5,870 Med/Surg $5,870 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, University of Rochester Medical Center | Transplant | Rochester | NY | Blood/Marrow (Autologous) | Autologous | Pediatric | Programs of Excellence | $167,300 | 25 | Days 25-45: $5,870 Med/Surg $5,870 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, University of Rochester Medical Center | Transplant | Rochester | NY | Heart | Heart | Pediatric | Member's Choice | $257,300 | 20 | Days 21-40: $5,770 Med/Surg $5,770 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, University of Rochester Medical Center | Transplant | Rochester | NY | Kidney | Kidney | Pediatric | Member's Choice | $104,100 | 15 | Days 16-35: $5,770 Med/Surg, $5,770 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, University of Rochester Medical Center | Transplant | Rochester | NY | Kidney/Pancreas | Kidney/Pancreas | Pediatric | Member's Choice | $187,500 | 20 | Days 21-40: $5,770 Med/Surg $5,770 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, University of Rochester Medical Center | Transplant | Rochester | NY | Liver | Liver | Pediatric | Member's Choice | Cadaveric Donor: $267,300 | Living Donor: $278,800 | 25 | Days 26-45: $5,770 Med/Surg, $5,770 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, University of Rochester Medical Center | Transplant | Rochester | NY | Pancreas | Pancreas | Pediatric | Member's Choice | $134,200 | 20 | Days 21-40: $5,770 Med/Surg $5,770 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, University of Rochester Medical Center | Transplant | Rochester | NY | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | $237,900 | 40 | Days 41-60: $5,870 Med/Surg $5,870 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, University of Rochester Medical Center | Transplant | Rochester | NY | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceQUALITY | $281,800 | 40 | Days 41-60: $5,870 Med/Surg $5,870 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, University of Rochester Medical Center | Transplant | Rochester | NY | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceQUALITY | $167,300 | 25 | Days 25-45: $5,870 Med/Surg $5,870 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, University of Rochester Medical Center | Transplant | Rochester | NY | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | $104,100 | 15 | Days 16-35: $5,770 Med/Surg, $5,770 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, University of Rochester Medical Center | Transplant | Rochester | NY | Liver | Liver | Adult | Programs of Excellence | PerformanceQUALITY | Cadaveric Donor: $267,300 | Living Donor: $278,800 | 25 | Days 26-45: $5,770 Med/Surg, $5,770 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, University of Rochester Medical Center | Transplant | Rochester | NY | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Adult | Programs of Excellence | PerformanceQUALITY | 1st Transplant: 100% of Higher Case Rate | 2nd Transplant: 75% of Second Case Rate | 1st Transplant: Global Period for Higher Case Rate | 2nd Transplant: New Period Begins | Days Associated with Higher Global Days: $5,600 Med/Surg, $5,600 ICU/CCU | Day Outlier Per Diem Period Ends-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, University of Rochester Medical Center | Transplant | Rochester | NY | Blood/Marrow (Tandem Auto to Allo) | Tandem Auto to Allo | Adult | Programs of Excellence | PerformanceQUALITY | 1st Transplant: 100% of Higher Case Rate | 2nd Transplant: 75% of Second Case Rate | 1st Transplant: Global Period for Higher Case Rate | 2nd Transplant: New Period Begins | Days Associated with Higher Global Days: $5,600 Med/Surg, $5,600 ICU/CCU | Day Outlier Per Diem Period Ends-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, University of Rochester Medical Center | Transplant | Rochester | NY | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Pediatric | Programs of Excellence | 1st Transplant: 100% of Higher Case Rate | 2nd Transplant: 75% of Second Case Rate | 1st Transplant: Global Period for Higher Case Rate | 2nd Transplant: New Period Begins | Days Associated with Higher Global Days: $5,600 Med/Surg, $5,600 ICU/CCU | Day Outlier Per Diem Period Ends-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, University of Rochester Medical Center | Transplant | Rochester | NY | Blood/Marrow (Tandem Auto to Allo) | Tandem Auto to Allo | Pediatric | Programs of Excellence | 1st Transplant: 100% of Higher Case Rate | 2nd Transplant: 75% of Second Case Rate | 1st Transplant: Global Period for Higher Case Rate | 2nd Transplant: New Period Begins | Days Associated with Higher Global Days: $5,600 Med/Surg, $5,600 ICU/CCU | Day Outlier Per Diem Period Ends-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 | ||||||||||||||||
| 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 | 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 | ||||||||||||||||
| Swedish Medical Center | Transplant | Seattle | WA | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | 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 | Liver | Liver | Adult | Programs of Excellence | PerformanceSELECT | 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 | |||||||||||||||
| Tampa General Hospital | Transplant | Tampa | FL | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | $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 | PerformanceQUALITY | 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 | PerformanceSELECT | $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 | PerformanceELITE | $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 | |||||||||||||||
| Tampa General Hospital | Transplant | Tampa | FL | Pancreas | Pancreas | Adult | Member's Choice | $80,000 | 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 | ||||||||||||||||
| 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 | Blood/Marrow (Tandem Auto to Auto) | Tandem Auto to Auto | Pediatric | Programs of Excellence | 1st Transplant: Hospital $60,000 Professional 70% | 2nd Transplant: Hospital $60,000 Professional $19,981 | 30 for Each Transplant | $1,800 Med/Surg | $2,400 ICU/CCU | 90% of Billed Charges | 70% of Billed Charges | 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 (Tandem Auto to Allo) | Tandem Auto to Allo | Pediatric | Programs of Excellence | Related: 1st Transplant: Hospital $60,000 Professional 70% | 2nd Transplant: Hospital $85,000 Professional $19,981 | Unrelated: 1st Transplant: Hospital $60,000 Professional 70% | 2nd Transplant: Hospital $95,000 Professional $19,981 | Related: 1st Transplant: 30 Days, 2nd Transplant: 35 Days | Unrelated: 1st Transplant: 30 Days, 2nd Transplant: 40 Days | $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 | Multi-Organ | Multi-Organ | Pediatric | Member's Choice | 70% of Billed Charges | N/A | N/A | N/A | 70% of Billed Charges | Reimbursed at Invoice Cost | N/A | 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 | 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 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 | ||||||||||||||||||||
| 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 | |||||||||||||||||||
| Texas Transplant Institute (Methodist Hospital Specialty and Transplant) | 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 (Methodist Hospital Specialty and Transplant) | 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 (Methodist Hospital Specialty and Transplant) | 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 (Methodist Hospital Specialty and Transplant) | 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 (Methodist Hospital Specialty and Transplant) | 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 | ||||||||||||||||
| Texas Transplant Institute (Methodist Hospital Specialty and Transplant) | Transplant | San Antonio | TX | Blood/Marrow (Autologous) | Autologous | Adult | Programs of Excellence | PerformanceQUALITY | $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 (Methodist Hospital Specialty and Transplant) | Transplant | San Antonio | TX | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | $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 (Methodist Hospital Specialty and Transplant) | Transplant | San Antonio | TX | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Programs of Excellence | PerformanceQUALITY | $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 (Methodist Hospital Specialty and Transplant) | Transplant | San Antonio | TX | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | $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 (Methodist Hospital Specialty and Transplant) | 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 (Methodist Hospital Specialty and Transplant) | 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 | |||||||||||||||
| The Jewish Hospital | Transplant | Cincinnati | OH | Blood/Marrow (Autologous) | Autologous | Adult | Member's Choice | $134,914 | 25 | $3,280 Med/Surg | $3,906 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 | Transplant | Cincinnati | OH | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Member's Choice | $229,208 | 30 | $3,280 Med/Surg | $3,906 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 | Transplant | Cincinnati | OH | Blood/Marrow (Allogeneic Unrelated) | Allogeneic Unrelated | Adult | Member's Choice | $287,234 | 40 | $3,280 Med/Surg | $3,906 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 | Transplant | Cincinnati | OH | Tandem (Auto-to-Auto) | Tandem Auto to Auto | Adult | Member's Choice | $242,845 | 1st: 25 | 2nd: 25 | $3,280 Med/Surg | $3,906 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 | Transplant | Cincinnati | OH | Tandem (Auto-to-Allo, Related) | Tandem Auto to Allo | Adult | Member's Choice | $318,282 | 1st: 25 | 2nd: 30 | $3,280Med/Surg | $3,906 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 | Transplant | Cincinnati | OH | Tandem (Auto-to-Allo, Unrelated) | Tandem Auto to Allo | Adult | Member's Choice | $362,672 | 1st: 25 | 2nd: 30 | $3,280 Med/Surg | $3,906 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 Nebraska Medical Center | Transplant | Omaha | NE | Blood/Marrow (Cord Blood) | Cord Blood | Adult | Programs of Excellence | PerformanceQUALITY | 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 | Programs of Excellence | PerformanceQUALITY | 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 (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 | ||||||||||||||||
| The Nebraska Medical Center | Transplant | Omaha | NE | Blood/Marrow (Tandem Auto-to-Auto) | Tandem Auto to Auto | Adult | Programs of Excellence | PerformanceQUALITY | 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 | Programs of Excellence | PerformanceQUALITY | $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 | Programs of Excellence | PerformanceQUALITY | $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 | Programs of Excellence | PerformanceQUALITY | $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 | PerformanceSELECT | $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 | PerformanceQUALITY | $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 (Cord Blood) | Cord Blood | Pediatric | Programs of Excellence | 75% of Billed Charges | N/A | N/A | N/A | 75% of Billed Charges | 75% of Billed Charges | 75% 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 One (1) Year from Day 31 Post Discharge | 41.2918376 | -96.1514595 | ||||||||||||||||
| The Nebraska Medical Center | Transplant | Omaha | NE | Tandem (Auto-to-Auto) | Tandem Auto to Auto | Pediatric | Programs of Excellence | 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 | Tandem (Auto-to-Allo) | Tandem Auto to Allo | Pediatric | Programs of Excellence | 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 | Intestine | Intestine | Adult | Member's Choice | 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 | Heart | Heart | Pediatric | Member's Choice | |||||||||||||||||||||||||||||
| 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 | |||||||||||||||||||
| The Nebraska Medical Center | Cancer | Omaha | NE | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 41.2918376 | -96.1514595 | ||||||||||||||||||||||||||||
| Thomas Jefferson University Hospital | Transplant | Philadelphia | PA | Blood/Marrow (Tandem Autologous-to-Autologous) | Tandem Auto to Auto | Adult | Programs of Excellence | PerformanceSELECT | 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 | 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 | ||||||||||||||||
| 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 | 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 | PerformanceSELECT | 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 | Multi-Organ | Multi-Organ | Adult | Member's Choice | 100% of Higher Cost Organ, Plus 50% of Lower Cost Organ | Equal to Organ with Longest Duration | 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 | 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 | |||||||||||||||||||
| 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 | ||||||||||||||||||||
| 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 | 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 | ||||||||||||||||
| Tufts Medical Center | Transplant | Boston | MA | Heart | Heart | Adult | Programs of Excellence | PerformanceQUALITY | $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 | 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 | |||||||||||||||||||
| Tufts Medical Center | Transplant | Boston | MA | Multi-Organ | Multi-Organ | Adult | Member's Choice | 100% of Higher Cost Organ, Plus 50% of Lower Cost Organ | N/A | N/A | 100% of Billed Charges | 80% of Billed Charges | Included in Case Rate | Invoice Cost | If Billed Charges Exceed 1.75 Times the Case Rate, 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 | 42.3143285 | -71.0404949 | ||||||||||||||||
| UF Health Shands Hospital | Transplant | Gainesville | FL | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Adult | Programs of Excellence | PerformanceQUALITY | $228,354 | N/A | N/A | 90% of Billed Charges | 80% of Billed Charges | 75% of Billed Charges | 100% of Billed Charges | Charges in Excess of $364,007 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 | Programs of Excellence | PerformanceQUALITY | $262,264 | N/A | N/A | 90% of Billed Charges | 80% of Billed Charges | 75% of Billed Charges | 100% of Billed Charges | Charges in Excess of $443,139 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 | Programs of Excellence | PerformanceQUALITY | Breast Cancer: $158,263 | Non-Breast Cancer: $192,559 | N/A | N/A | 90% of Billed Charges | 80% of Billed Charges | 75% of Billed Charges | 100% of Billed Charges | Charges in Excess of $291,656 (Breast Cancer) or $343,655 (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 | Blood/Marrow (Allogeneic Related) | Allogeneic Related | Pediatric | Member's Choice | $228,354 | N/A | N/A | 90% of Billed Charges | 80% of Billed Charges | 75% of Billed Charges | 100% of Billed Charges | Charges in Excess of $364,007 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 | Pediatric | Member's Choice | $262,264 | N/A | N/A | 90% of Billed Charges | 80% of Billed Charges | 75% of Billed Charges | 100% of Billed Charges | Charges in Excess of $443,139 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 | Pediatric | Member's Choice | Breast Cancer: $158,263 | Non-Breast Cancer: $192,559 | N/A | N/A | 90% of Billed Charges | 80% of Billed Charges | 75% of Billed Charges | 100% of Billed Charges | Charges in Excess of $291,656 (Breast Cancer) or $343,655 (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 | $296,180 | 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 $465,748 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 | Heart | Heart | Pediatric | Programs of Excellence | $296,180 | 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 $465,748 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: $94,956 | Living Donor: $85,915 | 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 $167,305(Cadaveric) or $156,004 (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 | Kidney | Pediatric | Member's Choice | Cadaveric Donor: $94,956 | Living Donor: $85,915 | 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 $167,305(Cadaveric) or $156,004 (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 | Member's Choice | $165,046 | 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 $284,872, 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 | Pediatric | Member's Choice | $165,046 | 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 $284,872, 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: $244,179 | Living Donor: $223,829 | 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 $400,183 (Cadaveric) or $379,833 (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: $192,175 | Bilateral: $221,568 | 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 $339,136 (Single Lung) or $393,396 (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 | Lung | Lung | Pediatric | Member's Choice | Single: $192,175 | Bilateral: $221,568 | 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 $339,136 (Single Lung) or $393,396 (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 | $293,917 | 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 $501,918 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 | Multi-Organ | Multi-Organ | Adult | Member's Choice | 75% of Billed Charges | N/A | N/A | N/A | 80% of Billed Charges | Cadaveric Donor: 100% of Billed Charges | Living Donor: 75% of Billed Charge | 80% 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 | 29.6864012 | -82.3897859 | ||||||||||||||||
| UF Health Shands Hospital | Transplant | Gainesville | FL | Multi-Organ | Multi-Organ | Pediatric | Member's Choice | 75% of Billed Charges | N/A | N/A | N/A | 80% of Billed Charges | Cadaveric Donor: 100% of Billed Charges | Living Donor: 75% of Billed Charge | 80% 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 | 29.6864012 | -82.3897859 | ||||||||||||||||
| UF Health Shands Hospital | Transplant | Gainesville | FL | Heart/Lung | Heart/Lung | Adult | Member's Choice | 75% of Billed Charges | N/A | N/A | N/A | 80% of Billed Charges | Cadaveric Donor: 100% of Billed Charges | Living Donor: 75% of Billed Charge | 80% 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 | 29.6864012 | -82.3897859 | ||||||||||||||||
| UF Health Shands Hospital | Transplant | Gainesville | FL | Heart/Lung | Heart/Lung | Pediatric | Member's Choice | 75% of Billed Charges | N/A | N/A | N/A | 80% of Billed Charges | Cadaveric Donor: 100% of Billed Charges | Living Donor: 75% of Billed Charge | 80% 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 | 29.6864012 | -82.3897859 | ||||||||||||||||
| UF Health Shands Hospital | Transplant | Gainesville | FL | Pancreas | Pancreas | Adult | Member's Choice | $128,872 | 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 $228,354 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 | Pancreas | Pancreas | Pediatric | Member's Choice | $128,872 | 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 $228,354 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 Hospital, University of Texas Health Science Center | Transplant | San Antonio | TX | Kidney | Kidney | Pediatric | Programs of Excellence | Cadaveric Donor | Hospital: $81,090 | Physician: $22,716 | Living Donor | Hospital: $72,080 | Physician: $28,694 | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | Reimbursed at Invoice Cost | N/A | If Billed Charges Exceed $202,725 (Cadaveric Hospital), $180,200 (Living Hospital) or $56,790 (Cadaveric Physician), $71,735 (Living Physician), 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 at Discharge | Ends One (1) Year from Discharge | 29.4813568 | -98.6548302 | ||||||||||||||||
| University Hospital, University of Texas Health Science Center | Transplant | San Antonio | TX | Liver | Liver | Pediatric | Member's Choice | Cadaveric Donor | Hospital: $162,710 | Physician: $60,973 | Living Donor | Hospital: $152,640 | Physician: $65,158 | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | Reimbursed at Invoice Cost | N/A | If Billed Charges Exceed $406,775 (Cadaveric Hospital), $381,600 (Living Hospital) or $152,433 (Cadaveric Physician), $162,895 (Living Physician), 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 at Discharge | Ends One (1) Year from Discharge | 29.4813568 | -98.6548302 | ||||||||||||||||
| University Hospital, University of Texas Health Science Center | Transplant | San Antonio | TX | Kidney/Pancreas | Kidney/Pancreas | Adult | Member's Choice | Hospital: $114,215 | Physician: $31,084 | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | Reimbursed at Invoice Cost | N/A | If Billed Charges Exceed $285,538 (Hospital) or $77,710 (Physician), 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 at Discharge | Ends One (1) Year from Discharge | 29.4813568 | -98.6548302 | ||||||||||||||||
| University Hospital, University of Texas Health Science Center | Transplant | San Antonio | TX | Kidney | Kidney | Adult | Programs of Excellence | PerformanceQUALITY | Cadaveric Donor | Hospital: $84,270 | Physician: $21,520 | Living Donor | Hospital: $74,730 | Physician: $26,303 | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | Reimbursed at Invoice Cost | N/A | If Billed Charges Exceed $210,675 (Cadaveric Hospital), $186,825 (Living Hospital) or $53,800 (Cadaveric Physician), $65,758 (Living Physician), 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 at Discharge | Ends One (1) Year from Discharge | 29.4813568 | -98.6548302 | |||||||||||||||
| University Hospital, University of Texas Health Science Center | Transplant | San Antonio | TX | Liver | Liver | Adult | Programs of Excellence | PerformanceELITE | Cadaveric Donor | Hospital: $162,710 | Physician: $60,973 | Living Donor | Hospital: $152,640 | Physician: $65,158 | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | Reimbursed at Invoice Cost | N/A | If Billed Charges Exceed $406,775 (Cadaveric Hospital), $381,600 (Living Hospital) or $152,433 (Cadaveric Physician), $162,895 (Living Physician), 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 at Discharge | Ends One (1) Year from Discharge | 29.4813568 | -98.6548302 | |||||||||||||||
| University Hospital, University of Texas Health Science Center | Transplant | San Antonio | TX | Lung | Lung | Adult | Programs of Excellence | PerformanceELITE | Single Lung |Hospital: $192,655 | Physician: $45,431 | Bilateral Lung | Hospital: $240,620 | Physician: $50,214 | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | Reimbursed at Invoice Cost | N/A | If Billed Charges Exceed $481,638 (Single Hospital), $601,550 (Double Hospital) or $113,578 (Single Physician), $125,535 (Double Physician), 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 at Discharge | Ends One (1) Year from Discharge | 29.4813568 | -98.6548302 | |||||||||||||||
| University Hospital, University of Texas Health Science Center | Transplant | San Antonio | TX | Pancreas | Pancreas | Adult | Member's Choice | Hospital: $69,430 | Physician: $22,716 | N/A | N/A | 90% of Billed Charges | 75% of Billed Charges | Reimbursed at Invoice Cost | N/A | If Billed Charges Exceed $381,600 (Hospital) or $56,790 (Physician), 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 at Discharge | Ends One (1) Year from Discharge | 29.4813568 | -98.6548302 | ||||||||||||||||
| University Hospital, University of Texas Health Science Center | Transplant | San Antonio | TX | Kidney | Kidney | Adult | Government Rates | Hospital: 120% of CMS Medicare Rate | Professional: 160% of CMS Medicare Rate | N/A | N/A | N/A | Hospital: 120% of CMS Medicare Rate | Professional: 160% of CMS Medicare Rate | 100% of Invoice Cost | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 29.4813568 | -98.6548302 | ||||||||||||||||
| University Hospital, University of Texas Health Science Center | Transplant | San Antonio | TX | Kidney/Liver | Kidney/Liver | Adult | Government Rates | Hospital: 120% of CMS Medicare Rate | Professional: 160% of CMS Medicare Rate | N/A | N/A | N/A | Hospital: 120% of CMS Medicare Rate | Professional: 160% of CMS Medicare Rate | 100% of Invoice Cost | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 29.4813568 | -98.6548302 | ||||||||||||||||
| University Hospital, University of Texas Health Science Center | Transplant | San Antonio | TX | Kidney/Pancreas | Kidney/Pancreas | Adult | Government Rates | Hospital: 120% of CMS Medicare Rate | Professional: 160% of CMS Medicare Rate | N/A | N/A | N/A | Hospital: 120% of CMS Medicare Rate | Professional: 160% of CMS Medicare Rate | 100% of Invoice Cost | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 29.4813568 | -98.6548302 | ||||||||||||||||
| University Hospital, University of Texas Health Science Center | Transplant | San Antonio | TX | Liver | Liver | Adult | Government Rates | Hospital: 120% of CMS Medicare Rate | Professional: 160% of CMS Medicare Rate | N/A | N/A | N/A | Hospital: 120% of CMS Medicare Rate | Professional: 160% of CMS Medicare Rate | 100% of Invoice Cost | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 29.4813568 | -98.6548302 | ||||||||||||||||
| University Hospital, University of Texas Health Science Center | Transplant | San Antonio | TX | Lung | Lung | Adult | Government Rates | Hospital: 120% of CMS Medicare Rate | Professional: 160% of CMS Medicare Rate | N/A | N/A | N/A | Hospital: 120% of CMS Medicare Rate | Professional: 160% of CMS Medicare Rate | 100% of Invoice Cost | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 29.4813568 | -98.6548302 | ||||||||||||||||
| University Hospital, University of Texas Health Science Center | Transplant | San Antonio | TX | Pancreas | Pancreas | Adult | Government Rates | Hospital: 120% of CMS Medicare Rate | Professional: 160% of CMS Medicare Rate | N/A | N/A | N/A | Hospital: 120% of CMS Medicare Rate | Professional: 160% of CMS Medicare Rate | 100% of Invoice Cost | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 29.4813568 | -98.6548302 | ||||||||||||||||
| University Hospital, University of Texas Health Science Center | Transplant | San Antonio | TX | Multi-Organ | Multi-Organ | Pediatric | Government Rates | Hospital: 120% of CMS Medicare Rate | Professional: 160% of CMS Medicare Rate | N/A | N/A | N/A | Hospital: 120% of CMS Medicare Rate | Professional: 160% of CMS Medicare Rate | 100% of Invoice Cost | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 29.4813568 | -98.6548302 | ||||||||||||||||
| University Hospital, University of Texas Health Science Center | Transplant | San Antonio | TX | Multi-Organ | Multi-Organ | Adult | Government Rates | Hospital: 120% of CMS Medicare Rate | Professional: 160% of CMS Medicare Rate | N/A | N/A | N/A | Hospital: 120% of CMS Medicare Rate | Professional: 160% of CMS Medicare Rate | 100% of Invoice Cost | 100% of Invoice Cost | N/A | Begins at Evaluation | Begins One (1) Day Prior to Transplant and Ends at Discharge | Begins at Discharge and Ends 1-Year Later | 29.4813568 | -98.6548302 | ||||||||||||||||
| University Hospitals of Cleveland | 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 of Cleveland | 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 of Cleveland | 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 of Cleveland | 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 of Cleveland | 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 of Cleveland | 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 of Cleveland | 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 of Cleveland | 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 of Cleveland | 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 of Cleveland | 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 of Cleveland | 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 of Cleveland | 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 of Cleveland | 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 of Cleveland | 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 of Cleveland | 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 Hospitals of Cleveland | Transplant | OH | Blood/Marrow (Cord Blood) | Cord Blood | Adult | Member's Choice | $392,266 | 30 | Hospital: $5,921 | 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 Days have Expired | Ends One (1) Year from Discharge | 41.4975107 | -81.7760709 | |||||||||||||||||
| University Hospitals of Cleveland | Transplant | OH | Blood/Marrow (Cord Blood) | Cord Blood | 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 of Cleveland | Cancer | Cleveland | OH | Cancer | Cancer | Contact INTERLINK for Contract Details | 800-599-9119 | 41.4975107 | -81.7760709 | ||||||||||||||||||||||||||||
| 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 | PerformanceSELECT | $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 | PerformanceELITE | $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 | Programs of Excellence | PerformanceQUALITY | $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 | Programs of Excellence | $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 Alabama Hospital | Transplant | Birmingham | AL | Kidney/Pancreas | Kidney/Pancreas | Pediatric | Member's Choice | $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 | Pancreas | Pancreas | Pediatric | 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 | 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 | |||||||||||||||||||
| 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 | PerformanceSELECT | $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 | Liver | Liver | Adult | Programs of Excellence | PerformanceELITE | $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 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 52.5% 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 52.5% 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 52.5% 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 52.5% 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 52.5% 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 52.5% 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 52.5% 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 52.5% 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 52.5% 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 52.5% 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 52.5% 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 52.5% 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 52.5% 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 52.5% 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 | 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 52.5% 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 52.5% 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 | Programs of Excellence | 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 52.5% 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 | Islet | Islet | Pediatric | 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/Pancreas | Kidney/Pancreas | Pediatric | 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 52.5% 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 | Pediatric | Member's Choice | 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 52.5% 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 | Pediatric | 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 52.5% 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-Organ | Multi-Organ | Pediatric | Member's Choice | Hospital: 70% of Billed Charges | Professional: %75 of Billed Charges | N/A | N/A | N/A | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | 100% of Hospital's Medicare Allowable Rate | Invoice Cost Plus 10% | 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 | Multi-Organ | Multi-Organ | Adult | Member's Choice | Hospital: 70% of Billed Charges | Professional: %75 of Billed Charges | N/A | N/A | N/A | Hospital and Professional: 75% of Billed Charges | Anesthesia: 80% of Billed Charges | 100% of Hospital's Medicare Allowable Rate | Invoice Cost Plus 10% | 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 | Intestine | Intestine | 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 52.5% 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 | Member's Choice | Hospital: $139,100 | Professional: $21,400 | 35 | N/A | 80% of Billed Charges | 65% of Billed Charges | Included in the Case Rate | Included in the Case Rate | 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 | Member's Choice | Hospital: $214,000 | Professional: $32,100 | 40 | N/A | 80% of Billed Charges | 65% of Billed Charges | Included in the Case Rate | Included in the Case Rate | 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 | Member's Choice | Hospital: $90,950 | Professional: $16,050 | 30 | N/A | 80% of Billed Charges | 65% of Billed Charges | Included in the Case Rate | Included in the Case Rate | 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 (Cord Blood) | Cord Blood | Adult | Member's Choice | Hospital: $251,450 | Professional: $37,450 | 40 | 80% of Billed Charges | 65% of Billed Charges | Included in the Case Rate | Included in the Case Rate | 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 (Tandem Auto to Auto) | Tandem Auto to Auto | Adult | Member's Choice | 1st Transplant: 100% of Transplant Type Case Rate | 2nd and Subsequent Transplants: 80% of Transplant Type Case Rate | N/A | 80% of Billed Charges | 65% of Billed Charges | Included in the Case Rate | Included in the Case Rate | 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 (Tandem Auto to Allo) | Tandem Auto to Allo | Adult | Member's Choice | 1st Transplant: 100% of Transplant Type Case Rate | 2nd and Subsequent Transplants: 80% of Transplant Type Case Rate | N/A | 80% of Billed Charges | 65% of Billed Charges | Included in the Case Rate | Included in the Case Rate | 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/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 | PerformanceSELECT | 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 |