Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

FETZIMA ER 80MG CAP EMP

Facility

OP

$20.00

Service Code	NDC 456228030
Hospital Charge Code	2624236
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

FEVER AND INFLAMMATORY CONDITIONS

Facility

IP

$17,536.46

Service Code	MSDRG 864
Min. Negotiated Rate	$8,768.23
Max. Negotiated Rate	$17,536.46
Rate for Payer: Aetna Medicare Advantage	$8,768.23
Rate for Payer: Cigna Commercial HMO & PPO	$8,768.23
Rate for Payer: Home State Health Plan Medicare Advantage	$8,768.23
Rate for Payer: Humana Commercial	$17,536.46
Rate for Payer: Humana Medicare Advantage	$8,768.23

FEVER AND INFLAMMATORY CONDITIONS

Facility

IP

$5,395.54

Service Code	APR-DRG 7222
Min. Negotiated Rate	$5,395.54
Max. Negotiated Rate	$5,395.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,395.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,395.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,395.54
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,395.54

FEVER AND INFLAMMATORY CONDITIONS

Facility

IP

$11,990.09

Service Code	APR-DRG 7223
Min. Negotiated Rate	$11,990.09
Max. Negotiated Rate	$11,990.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,990.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,990.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,990.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,990.09

FEVER AND INFLAMMATORY CONDITIONS

Facility

IP

$4,946.21

Service Code	APR-DRG 7221
Min. Negotiated Rate	$4,946.21
Max. Negotiated Rate	$4,946.21
Rate for Payer: Aetna Better Health Medicaid/QHP	$4,946.21
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,946.21
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4,946.21
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4,946.21

FEVER AND INFLAMMATORY CONDITIONS

Facility

IP

$16,164.82

Service Code	APR-DRG 7224
Min. Negotiated Rate	$16,164.82
Max. Negotiated Rate	$16,164.82
Rate for Payer: Aetna Better Health Medicaid/QHP	$16,164.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16,164.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16,164.82
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16,164.82

FEXOFENADINE (ALLEGRA) 180MG TAB

Facility

OP

$35.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2626383
Hospital Revenue Code	250
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$24.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.99
Rate for Payer: Cash Price	$31.50
Rate for Payer: UnitedHealthcare Commercial	$23.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

FEXOFENADINE (ALLEGRA) 180MG TAB

Facility

IP

$35.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2626383
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

FFP

Facility

IP

$357.00

Service Code	CPT P9059
Hospital Charge Code	226063
Hospital Revenue Code	302
Rate for Payer: Cash Price	$321.30

FFP

Facility

OP

$357.00

Service Code	CPT P9059
Hospital Charge Code	226063
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$254.90
Rate for Payer: Aetna Medicare Advantage	$73.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$211.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$254.90
Rate for Payer: Cash Price	$321.30
Rate for Payer: Cash Price	$321.30
Rate for Payer: Cigna Commercial HMO & PPO	$73.77
Rate for Payer: Home State Health Plan Medicare Advantage	$73.77
Rate for Payer: Humana Commercial	$147.54
Rate for Payer: Humana Medicare Advantage	$73.77
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$128.52

FFP THAWING

Facility

IP

$131.00

Service Code	CPT 86927
Hospital Charge Code	2286927
Hospital Revenue Code	390
Rate for Payer: Cash Price	$117.90

FFP THAWING

Facility

OP

$131.00

Service Code	CPT 86927
Hospital Charge Code	2286927
Hospital Revenue Code	390
Min. Negotiated Rate	$47.16
Max. Negotiated Rate	$348.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$153.58
Rate for Payer: Aetna Medicare Advantage	$174.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$77.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$93.53
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cigna Commercial HMO & PPO	$174.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$153.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$164.33
Rate for Payer: Home State Health Plan Medicare Advantage	$174.06
Rate for Payer: Humana Commercial	$348.12
Rate for Payer: Humana Medicare Advantage	$174.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$153.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.16

FIBERGLASS CAST 2

Facility

IP

$60.00

Hospital Charge Code	283020
Hospital Revenue Code	271
Rate for Payer: Cash Price	$54.00

FIBERGLASS CAST 2

Facility

OP

$60.00

Hospital Charge Code	283020
Hospital Revenue Code	271
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

FIBERGLASS CAST 3

Facility

OP

$67.00

Hospital Charge Code	283022
Hospital Revenue Code	271
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: UnitedHealthcare Commercial	$44.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

FIBERGLASS CAST 3

Facility

IP

$67.00

Hospital Charge Code	283022
Hospital Revenue Code	271
Rate for Payer: Cash Price	$60.30

FIBERGLASS CAST 3 #82003B BLUE

Facility

OP

$62.00

Hospital Charge Code	403022
Hospital Revenue Code	271
Min. Negotiated Rate	$22.32
Max. Negotiated Rate	$44.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$36.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.27
Rate for Payer: Cash Price	$55.80
Rate for Payer: UnitedHealthcare Commercial	$41.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.32

FIBERGLASS CAST 3 #82003B BLUE

Facility

IP

$62.00

Hospital Charge Code	403022
Hospital Revenue Code	271
Rate for Payer: Cash Price	$55.80

FIBERGLASS CAST 4

Facility

OP

$81.00

Hospital Charge Code	283021
Hospital Revenue Code	271
Min. Negotiated Rate	$29.16
Max. Negotiated Rate	$57.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.83
Rate for Payer: Cash Price	$72.90
Rate for Payer: UnitedHealthcare Commercial	$54.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.16

FIBERGLASS CAST 4

Facility

IP

$81.00

Hospital Charge Code	283021
Hospital Revenue Code	271
Rate for Payer: Cash Price	$72.90

FIBERGLASS CAST 4 PINK #82004X

Facility

OP

$70.00

Hospital Charge Code	403021
Hospital Revenue Code	271
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$49.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

FIBERGLASS CAST 4 PINK #82004X

Facility

IP

$70.00

Hospital Charge Code	403021
Hospital Revenue Code	271
Rate for Payer: Cash Price	$63.00

FIBERLAX 625MG TAB

Facility

OP

$13.00

Service Code	NDC 536430611
Hospital Charge Code	2697607
Hospital Revenue Code	250
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

FIBERLAX 625MG TAB

Facility

IP

$13.00

Service Code	NDC 536430611
Hospital Charge Code	2697607
Hospital Revenue Code	250
Rate for Payer: Cash Price	$11.70

FIBOBLAST GROWTH FACTOR 23

Facility

IP

$520.00

Service Code	CPT 83520
Hospital Charge Code	2283528
Hospital Revenue Code	301
Rate for Payer: Cash Price	$468.00

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