Madison Medical Center

All Charges

Charge

Type

Setting

Price

LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC

Facility

$38,758.26

Service Code	MSDRG 821
Min. Negotiated Rate	$19,379.13
Max. Negotiated Rate	$38,758.26
Rate for Payer: Aetna Medicare Advantage	$19,379.13
Rate for Payer: Cigna Commercial HMO & PPO	$19,379.13
Rate for Payer: Home State Health Plan Medicare Advantage	$19,379.13
Rate for Payer: Humana Commercial	$38,758.26
Rate for Payer: Humana Medicare Advantage	$19,379.13

LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC

Facility

$96,236.14

Service Code	MSDRG 820
Min. Negotiated Rate	$48,118.07
Max. Negotiated Rate	$96,236.14
Rate for Payer: Aetna Medicare Advantage	$48,118.07
Rate for Payer: Cigna Commercial HMO & PPO	$48,118.07
Rate for Payer: Home State Health Plan Medicare Advantage	$48,118.07
Rate for Payer: Humana Commercial	$96,236.14
Rate for Payer: Humana Medicare Advantage	$48,118.07

LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC

Facility

$22,486.34

Service Code	MSDRG 822
Min. Negotiated Rate	$11,243.17
Max. Negotiated Rate	$22,486.34
Rate for Payer: Aetna Medicare Advantage	$11,243.17
Rate for Payer: Cigna Commercial HMO & PPO	$11,243.17
Rate for Payer: Home State Health Plan Medicare Advantage	$11,243.17
Rate for Payer: Humana Commercial	$22,486.34
Rate for Payer: Humana Medicare Advantage	$11,243.17

LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC

Facility

$29,192.58

Service Code	MSDRG 841
Min. Negotiated Rate	$14,596.29
Max. Negotiated Rate	$29,192.58
Rate for Payer: Aetna Medicare Advantage	$14,596.29
Rate for Payer: Cigna Commercial HMO & PPO	$14,596.29
Rate for Payer: Home State Health Plan Medicare Advantage	$14,596.29
Rate for Payer: Humana Commercial	$29,192.58
Rate for Payer: Humana Medicare Advantage	$14,596.29

LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC

Facility

$54,503.42

Service Code	MSDRG 840
Min. Negotiated Rate	$27,251.71
Max. Negotiated Rate	$54,503.42
Rate for Payer: Aetna Medicare Advantage	$27,251.71
Rate for Payer: Cigna Commercial HMO & PPO	$27,251.71
Rate for Payer: Home State Health Plan Medicare Advantage	$27,251.71
Rate for Payer: Humana Commercial	$54,503.42
Rate for Payer: Humana Medicare Advantage	$27,251.71

LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC

Facility

$39,183.62

Service Code	MSDRG 824
Min. Negotiated Rate	$19,591.81
Max. Negotiated Rate	$39,183.62
Rate for Payer: Aetna Medicare Advantage	$19,591.81
Rate for Payer: Cigna Commercial HMO & PPO	$19,591.81
Rate for Payer: Home State Health Plan Medicare Advantage	$19,591.81
Rate for Payer: Humana Commercial	$39,183.62
Rate for Payer: Humana Medicare Advantage	$19,591.81

LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC

Facility

$75,916.58

Service Code	MSDRG 823
Min. Negotiated Rate	$37,958.29
Max. Negotiated Rate	$75,916.58
Rate for Payer: Aetna Medicare Advantage	$37,958.29
Rate for Payer: Cigna Commercial HMO & PPO	$37,958.29
Rate for Payer: Home State Health Plan Medicare Advantage	$37,958.29
Rate for Payer: Humana Commercial	$75,916.58
Rate for Payer: Humana Medicare Advantage	$37,958.29

LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC

Facility

$24,761.76

Service Code	MSDRG 825
Min. Negotiated Rate	$12,380.88
Max. Negotiated Rate	$24,761.76
Rate for Payer: Aetna Medicare Advantage	$12,380.88
Rate for Payer: Cigna Commercial HMO & PPO	$12,380.88
Rate for Payer: Home State Health Plan Medicare Advantage	$12,380.88
Rate for Payer: Humana Commercial	$24,761.76
Rate for Payer: Humana Medicare Advantage	$12,380.88

LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC

Facility

$19,456.64

Service Code	MSDRG 842
Min. Negotiated Rate	$9,728.32
Max. Negotiated Rate	$19,456.64
Rate for Payer: Aetna Medicare Advantage	$9,728.32
Rate for Payer: Cigna Commercial HMO & PPO	$9,728.32
Rate for Payer: Home State Health Plan Medicare Advantage	$9,728.32
Rate for Payer: Humana Commercial	$19,456.64
Rate for Payer: Humana Medicare Advantage	$9,728.32

LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA

Facility

$15,810.20

Service Code	APR-DRG 6912
Min. Negotiated Rate	$15,810.20
Max. Negotiated Rate	$15,810.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,810.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,810.20
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,810.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,810.20

LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA

Facility

$46,239.82

Service Code	APR-DRG 6914
Min. Negotiated Rate	$46,239.82
Max. Negotiated Rate	$46,239.82
Rate for Payer: Aetna Better Health Medicaid/QHP	$46,239.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$46,239.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$46,239.82
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$46,239.82

LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA

Facility

$12,309.97

Service Code	APR-DRG 6911
Min. Negotiated Rate	$12,309.97
Max. Negotiated Rate	$12,309.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,309.97
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,309.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,309.97
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,309.97

LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA

Facility

$23,929.33

Service Code	APR-DRG 6913
Min. Negotiated Rate	$23,929.33
Max. Negotiated Rate	$23,929.33
Rate for Payer: Aetna Better Health Medicaid/QHP	$23,929.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23,929.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23,929.33
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23,929.33

LYMPH SUBSET-ABS.CD4,CD8

Facility

$150.00

Service Code	CPT 86360
Hospital Charge Code	2286356
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$107.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$42.28
Rate for Payer: Aetna Medicare Advantage	$46.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.10
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cigna Commercial HMO & PPO	$46.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$42.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$45.24
Rate for Payer: Home State Health Plan Medicare Advantage	$46.98
Rate for Payer: Humana Commercial	$93.96
Rate for Payer: Humana Medicare Advantage	$46.98
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$42.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.00

LYMPH SUBSET-ABS.CD4,CD8

Facility

$150.00

Service Code	CPT 86360
Hospital Charge Code	2286356
Hospital Revenue Code	305
Rate for Payer: Cash Price	$135.00

LYMPH SUBSET-BCELL

Facility

$150.00

Service Code	CPT 86355
Hospital Charge Code	2286355
Hospital Revenue Code	305
Rate for Payer: Cash Price	$135.00

LYMPH SUBSET-BCELL

Facility

$150.00

Service Code	CPT 86355
Hospital Charge Code	2286355
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$107.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$33.96
Rate for Payer: Aetna Medicare Advantage	$37.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.10
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cigna Commercial HMO & PPO	$37.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$33.96
Rate for Payer: Home State Health Plan Medicaid Managed Care	$36.34
Rate for Payer: Home State Health Plan Medicare Advantage	$37.73
Rate for Payer: Humana Commercial	$75.46
Rate for Payer: Humana Medicare Advantage	$37.73
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.00

LYMPH SUBSET-NKCELLS

Facility

$150.00

Service Code	CPT 86357
Hospital Charge Code	2286357
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$107.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$33.96
Rate for Payer: Aetna Medicare Advantage	$37.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.10
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cigna Commercial HMO & PPO	$37.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$33.96
Rate for Payer: Home State Health Plan Medicaid Managed Care	$36.34
Rate for Payer: Home State Health Plan Medicare Advantage	$37.73
Rate for Payer: Humana Commercial	$75.46
Rate for Payer: Humana Medicare Advantage	$37.73
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.00

LYMPH SUBSET-NKCELLS

Facility

$150.00

Service Code	CPT 86357
Hospital Charge Code	2286357
Hospital Revenue Code	305
Rate for Payer: Cash Price	$135.00

LYMPH SUBSET-TCELL,TOTAL

Facility

$150.00

Service Code	CPT 86359
Hospital Charge Code	2286358
Hospital Revenue Code	305
Rate for Payer: Cash Price	$135.00

LYMPH SUBSET-TCELL,TOTAL

Facility

$150.00

Service Code	CPT 86359
Hospital Charge Code	2286358
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$107.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$33.96
Rate for Payer: Aetna Medicare Advantage	$37.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.10
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cigna Commercial HMO & PPO	$37.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$33.96
Rate for Payer: Home State Health Plan Medicaid Managed Care	$36.34
Rate for Payer: Home State Health Plan Medicare Advantage	$37.73
Rate for Payer: Humana Commercial	$75.46
Rate for Payer: Humana Medicare Advantage	$37.73
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.00

LYSIS OF PENILE ADHESIONS

Facility

$760.00

Service Code	CPT 54162
Hospital Charge Code	9854162
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$4,271.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,884.38
Rate for Payer: Aetna Medicare Advantage	$2,135.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$449.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$542.64
Rate for Payer: Cash Price	$684.00
Rate for Payer: Cash Price	$684.00
Rate for Payer: Cash Price	$684.00
Rate for Payer: Cash Price	$684.00
Rate for Payer: Cigna Commercial HMO & PPO	$2,135.66
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,695.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$2,016.29
Rate for Payer: Home State Health Plan Medicare Advantage	$2,135.66
Rate for Payer: Humana Commercial	$4,271.32
Rate for Payer: Humana Medicare Advantage	$2,135.66
Rate for Payer: UnitedHealthcare Commercial	$506.92
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,884.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

LYSIS OF PENILE ADHESIONS

Facility

$760.00

Service Code	CPT 54162
Hospital Charge Code	9854162
Hospital Revenue Code	521
Rate for Payer: Cash Price	$684.00

LYSOSOMAL ACID LIPASE (LC402300)

Facility

$470.00

Service Code	CPT 82657
Hospital Charge Code	2282658
Hospital Revenue Code	307
Min. Negotiated Rate	$19.95
Max. Negotiated Rate	$335.58
Rate for Payer: Aetna Better Health Medicaid/QHP	$19.95
Rate for Payer: Aetna Medicare Advantage	$22.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$278.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$335.58
Rate for Payer: Cash Price	$423.00
Rate for Payer: Cash Price	$423.00
Rate for Payer: Cash Price	$423.00
Rate for Payer: Cigna Commercial HMO & PPO	$22.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21.35
Rate for Payer: Home State Health Plan Medicare Advantage	$22.17
Rate for Payer: Humana Commercial	$44.34
Rate for Payer: Humana Medicare Advantage	$22.17
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$169.20

LYSOSOMAL ACID LIPASE (LC402300)

Facility

$470.00

Service Code	CPT 82657
Hospital Charge Code	2282658
Hospital Revenue Code	307
Rate for Payer: Cash Price	$423.00

Know your out-of-pocket cost for care.

All Charges