Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

SIMVASTATIN (ZOCOR) 10MG TAB EMP

Facility

OP

$42.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2624456
Hospital Revenue Code	250
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$29.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.99
Rate for Payer: Cash Price	$37.80
Rate for Payer: UnitedHealthcare Commercial	$28.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

SIMVASTATIN (ZOCOR) 10MG TAB EMP

Facility

IP

$42.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2624456
Hospital Revenue Code	250
Rate for Payer: Cash Price	$37.80

SIMVASTATIN (ZOCOR) 20MG TAB

Facility

IP

$40.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2626472
Hospital Revenue Code	250
Rate for Payer: Cash Price	$36.00

SIMVASTATIN (ZOCOR) 20MG TAB

Facility

OP

$40.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2626472
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

SIMVASTATIN (ZOCOR) 40MG TAB

Facility

OP

$42.00

Hospital Charge Code	2626473
Hospital Revenue Code	250
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$29.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.99
Rate for Payer: Cash Price	$37.80
Rate for Payer: UnitedHealthcare Commercial	$28.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

SIMVASTATIN (ZOCOR) 40MG TAB

Facility

IP

$42.00

Hospital Charge Code	2626473
Hospital Revenue Code	250
Rate for Payer: Cash Price	$37.80

SIMVASTATIN (ZOCOR) 40MG TAB EMP

Facility

OP

$42.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2697553
Hospital Revenue Code	250
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$29.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.99
Rate for Payer: Cash Price	$37.80
Rate for Payer: UnitedHealthcare Commercial	$28.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

SIMVASTATIN (ZOCOR) 40MG TAB EMP

Facility

IP

$42.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2697553
Hospital Revenue Code	250
Rate for Payer: Cash Price	$37.80

SINCALIDE (KINEVAC) 5MCG VIAL

Facility

OP

$568.00

Service Code	NDC 270055615
Hospital Charge Code	2697144
Hospital Revenue Code	250
Min. Negotiated Rate	$204.48
Max. Negotiated Rate	$405.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$336.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$405.55
Rate for Payer: Cash Price	$511.20
Rate for Payer: UnitedHealthcare Commercial	$378.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$204.48

SINCALIDE (KINEVAC) 5MCG VIAL

Facility

IP

$568.00

Service Code	NDC 270055615
Hospital Charge Code	2697144
Hospital Revenue Code	250
Rate for Payer: Cash Price	$511.20

SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL

Facility

IP

$43,628.98

Service Code	APR-DRG 3003
Min. Negotiated Rate	$43,628.98
Max. Negotiated Rate	$43,628.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$43,628.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$43,628.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$43,628.98
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$43,628.98

SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL

Facility

IP

$32,537.52

Service Code	APR-DRG 3002
Min. Negotiated Rate	$32,537.52
Max. Negotiated Rate	$32,537.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$32,537.52
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$32,537.52
Rate for Payer: Home State Health Plan Medicaid Managed Care	$32,537.52
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$32,537.52

SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL

Facility

IP

$20,160.06

Service Code	APR-DRG 3001
Min. Negotiated Rate	$20,160.06
Max. Negotiated Rate	$20,160.06
Rate for Payer: Aetna Better Health Medicaid/QHP	$20,160.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20,160.06
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20,160.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20,160.06

SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL

Facility

IP

$66,960.64

Service Code	MSDRG 402
Min. Negotiated Rate	$33,480.32
Max. Negotiated Rate	$66,960.64
Rate for Payer: Aetna Medicare Advantage	$33,480.32
Rate for Payer: Cigna Commercial HMO & PPO	$33,480.32
Rate for Payer: Home State Health Plan Medicare Advantage	$33,480.32
Rate for Payer: Humana Commercial	$66,960.64
Rate for Payer: Humana Medicare Advantage	$33,480.32

SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL

Facility

IP

$70,087.79

Service Code	APR-DRG 3004
Min. Negotiated Rate	$70,087.79
Max. Negotiated Rate	$70,087.79
Rate for Payer: Aetna Better Health Medicaid/QHP	$70,087.79
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$70,087.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$70,087.79
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$70,087.79

SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE

Facility

IP

$87,740.00

Service Code	MSDRG 450
Min. Negotiated Rate	$43,870.00
Max. Negotiated Rate	$87,740.00
Rate for Payer: Aetna Medicare Advantage	$43,870.00
Rate for Payer: Cigna Commercial HMO & PPO	$43,870.00
Rate for Payer: Home State Health Plan Medicare Advantage	$43,870.00
Rate for Payer: Humana Commercial	$87,740.00
Rate for Payer: Humana Medicare Advantage	$43,870.00

SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC

Facility

IP

$54,432.24

Service Code	MSDRG 451
Min. Negotiated Rate	$27,216.12
Max. Negotiated Rate	$54,432.24
Rate for Payer: Aetna Medicare Advantage	$27,216.12
Rate for Payer: Cigna Commercial HMO & PPO	$27,216.12
Rate for Payer: Home State Health Plan Medicare Advantage	$27,216.12
Rate for Payer: Humana Commercial	$54,432.24
Rate for Payer: Humana Medicare Advantage	$27,216.12

SINUS AND MASTOID PROCEDURES WITH CC/MCC

Facility

IP

$37,677.56

Service Code	MSDRG 135
Min. Negotiated Rate	$18,838.78
Max. Negotiated Rate	$37,677.56
Rate for Payer: Aetna Medicare Advantage	$18,838.78
Rate for Payer: Cigna Commercial HMO & PPO	$18,838.78
Rate for Payer: Home State Health Plan Medicare Advantage	$18,838.78
Rate for Payer: Humana Commercial	$37,677.56
Rate for Payer: Humana Medicare Advantage	$18,838.78

SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC

Facility

IP

$19,533.32

Service Code	MSDRG 136
Min. Negotiated Rate	$9,766.66
Max. Negotiated Rate	$19,533.32
Rate for Payer: Humana Medicare Advantage	$9,766.66
Rate for Payer: Aetna Medicare Advantage	$9,766.66
Rate for Payer: Cigna Commercial HMO & PPO	$9,766.66
Rate for Payer: Home State Health Plan Medicare Advantage	$9,766.66
Rate for Payer: Humana Commercial	$19,533.32

SINUSES

Facility

OP

$625.00

Service Code	CPT 70220
Hospital Charge Code	3219104
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$446.25
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$370.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$446.25
Rate for Payer: Cash Price	$562.50
Rate for Payer: Cash Price	$562.50
Rate for Payer: Cash Price	$562.50
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$225.00

SINUSES

Facility

IP

$625.00

Service Code	CPT 70220
Hospital Charge Code	3219104
Hospital Revenue Code	320
Rate for Payer: Cash Price	$562.50

SITAGLIPTIN (JANUVIA) 100MG TAB EMP

Facility

IP

$55.00

Service Code	NDC 6027731
Hospital Charge Code	2622505
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

SITAGLIPTIN (JANUVIA) 100MG TAB EMP

Facility

OP

$55.00

Service Code	NDC 6027731
Hospital Charge Code	2622505
Hospital Revenue Code	250
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

SITAGLIPTIN (JANUVIA) 25MG TAB

Facility

IP

$67.00

Service Code	NDC 6022101
Hospital Charge Code	2626474
Hospital Revenue Code	250
Rate for Payer: Cash Price	$60.30

SITAGLIPTIN (JANUVIA) 25MG TAB

Facility

OP

$67.00

Service Code	NDC 6022101
Hospital Charge Code	2626474
Hospital Revenue Code	250
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

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