Health Alliance MH Employee Plan: disclosed hospital rates

iDirect answer

Based on the published hospital price files, Health Alliance MH Employee Plan appears in disclosed negotiated rates across 1 hospital and 316 services. This is public hospital price transparency data, not a guaranteed estimate of your bill.

Actual patient responsibility may vary based on your insurance plan, deductible, coinsurance, network status, diagnosis, setting, bundled services, clinical circumstances, and hospital billing practices.

316 prices shown.

Service	Hospital	Code	List price	Cash price	Negotiated range	Allowed (median)
00009-0003-02 - methylPREDNISolone 500 mg Pres Fre Inpatient	Decatur Memorial Hospital	J2919 HCPCS	$429	$429	$197 – $429	—
00009-0003-02 - methylPREDNISolone 500 mg Pres Fre Outpatient	Decatur Memorial Hospital	J2919 HCPCS	$429	$429	$104 – $429	—
00187-4303-05 - amobarbital 0.5 gm Inj Inpatient	Decatur Memorial Hospital	J0300 HCPCS	$3,332	$3,332	$1,533 – $3,332	—
00187-4303-05 - amobarbital 0.5 gm Inj Outpatient	Decatur Memorial Hospital	J0300 HCPCS	$3,332	$3,332	$810 – $3,332	—
13533-0800-20 - immune globulin intravenous and su Inpatient	Decatur Memorial Hospital	J1561 HCPCS	$3,839	$3,839	$1,766 – $3,839	—
13533-0800-20 - immune globulin intravenous and su Outpatient	Decatur Memorial Hospital	J1561 HCPCS	$3,839	$3,839	$933 – $3,839	—
18860-0720-10 - ziconotide 100 mcg/mL Sol Inpatient	Decatur Memorial Hospital	J2278 HCPCS	$4,966	$4,966	$2,284 – $4,966	—
18860-0720-10 - ziconotide 100 mcg/mL Sol Outpatient	Decatur Memorial Hospital	J2278 HCPCS	$4,966	$4,966	$1,207 – $4,966	—
50242-0070-01 - obinutuzumab 25 mg/mL Sol Inpatient	Decatur Memorial Hospital	J9301 HCPCS	$622	$622	$286 – $622	—
50242-0070-01 - obinutuzumab 25 mg/mL Sol Outpatient	Decatur Memorial Hospital	J9301 HCPCS	$622	$622	$151 – $622	—
55566-2300-00 - desmopressin 4 mcg/mL Inj Inpatient	Decatur Memorial Hospital	J2597 HCPCS	$195	$195	$89.76 – $195	—
55566-2300-00 - desmopressin 4 mcg/mL Inj Outpatient	Decatur Memorial Hospital	J2597 HCPCS	$195	$195	$47.42 – $195	—
59676-0610-01 - trabectedin 1 mg PWD Inpatient	Decatur Memorial Hospital	J9352 HCPCS	$22,286	$22,286	$10,252 – $22,286	—
59676-0610-01 - trabectedin 1 mg PWD Outpatient	Decatur Memorial Hospital	J9352 HCPCS	$22,286	$22,286	$3,121 – $22,286	—
61364-0181-03 - peramivir 10 mg/mL 20mL vial Inpatient	Decatur Memorial Hospital	J2547 HCPCS	$1,267	$1,267	$583 – $1,267	—
61364-0181-03 - peramivir 10 mg/mL 20mL vial Outpatient	Decatur Memorial Hospital	J2547 HCPCS	$1,267	$1,267	$308 – $1,267	—
63323-0593-03 - glucagon 1 mg Inj Inpatient	Decatur Memorial Hospital	J1611 HCPCS	$451	$451	$207 – $451	—
63323-0593-03 - glucagon 1 mg Inj Outpatient	Decatur Memorial Hospital	J1611 HCPCS	$451	$451	$109 – $451	—
63323-0594-03 - glucagon 1 mg Inj Inpatient	Decatur Memorial Hospital	J1611 HCPCS	$451	$451	$207 – $451	—
63323-0594-03 - glucagon 1 mg Inj Outpatient	Decatur Memorial Hospital	J1611 HCPCS	$451	$451	$109 – $451	—
63833-0617-02 - antihemophilic factor-von Willebra Inpatient	Decatur Memorial Hospital	J7187 HCPCS	$5.05	$5.05	$2.32 – $5.05	—
63833-0617-02 - antihemophilic factor-von Willebra Outpatient	Decatur Memorial Hospital	J7187 HCPCS	$5.05	$5.05	$1.23 – $5.05	—
66220-0160-10 - conivaptan 20 mg/100 mL-D5 Sol Inpatient	Decatur Memorial Hospital	C9488 HCPCS	$4,051	$4,051	$1,863 – $4,051	—
66220-0160-10 - conivaptan 20 mg/100 mL-D5 Sol Outpatient	Decatur Memorial Hospital	C9488 HCPCS	$4,051	$4,051	$856 – $4,051	—
67457-0366-10 - ibutilide 0.1 mg/mL Sol Inpatient	Decatur Memorial Hospital	J1742 HCPCS	$612	$612	$282 – $612	—