How many shoppable procedure prices are published for SSM St Clare Health Center?

SSM St Clare Health Center in Fenton, MO currently has 128 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do SSM St Clare Health Center's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, SSM St Clare Health Center's median negotiated commercial rate is 1.0× the regionally adjusted fair BaseRate benchmark.

What is SSM St Clare Health Center's CMS Care Compare overall star rating?

CMS Care Compare assigns SSM St Clare Health Center an overall hospital quality rating of 4 out of 5 stars based on public federal clinical and patient-experience measures.

Hospital Profile Acute Care Hospital Voluntary non-profit - Private 180 Beds · urban Updated: 2026-04-01

SSM St Clare Health Center

1015 Bowles, Fenton, MO 63026 · 128 Priced Procedures · 75% Patient Recommendation

CMS Overall Rating 4 / 5 Stars

Near Fair BaseRate Benchmark

1.01×vs. Fair Market Price

Typical commercial prices here match the fair market benchmark (1.01×) after accounting for local nurse/doctor wages and patient complexity.

91/100 · Verified

91/100Self-Pay Cash Beats Insurance 13% of the Time

File Completeness100

Price Logic91

Peer Alignment70

Clean Billing92

Real Cash Discount100

Regional Value Leader

3-Star CMS clinical quality rating paired with 1.01× fair market pricing.

Behavioral Pricing FingerprintMedian-Gamed · High Captive Markup

Loss-Leader / Captive Ancillary Cross-Subsidizer

SSM St Clare Health Center prices routine shoppable procedures near 1.1× Medicare (p50 1.09×) while skewing captive emergency, lab, and upper-quartile codes to 1.8× Medicare (p75 1.48×, +36% upper-tail jump). Patients scheduling elective outpatient care can capture competitive rates, but emergency and ancillary bills require strict line-item auditing.

#33 of 79 in MO · 40th State Percentile#1,334 of 3,385 in U.S. · 39th National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Bottom-quartile procedures (Q25) price at 0.81× the peer BaseRate benchmark
Self-pay cash beats commercial insurance on 13% of shoppable procedures (99/100 Cash Honesty)
4-Star CMS clinical rating with 75% patient recommendation (66/100 safety score)
IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (17.7% AGB cap)

Watchout

Where You Can Get Burned (Markup Traps)

Outpatient surgery & OR suites carry a 1.4× markup over Medicare rates
Captive ER (1.6×) & laboratory (1.5×) services average 1.64× higher multiples than routine shoppable care (1.1×)
Upper-quartile procedures (Q75 1.48×) jump +36% above the median procedure ratio (Q50 1.09×)
Unnegotiated chargemaster list prices average 8.8× Medicare (14¢ true HCRIS cost per $1 gross)

Front-Door ShoppableElective / Imaging

1.1× Medicare

Pre-scheduled outpatient procedures where patients can comparison-shop.

Back-Door Captive & ER1.64× Divergence

1.8× Medicare

Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.

Quantile Tail Spread+36% Upper Tail

Q25 0.81× · Q50 1.09× · Q75 1.48×

Detects median-gaming when upper-quartile codes spike above the p50 median.

Select any lens to inspect department markups, federal cost accounting, or insurer discounts.

Department & Integrity Multiples (vs. CMS Medicare Cost Anchor) Green ≤1.3× · Teal 1.3–1.8× · Amber 1.8–2.5× · Rose >2.5×

Front-Door Shoppable CareFront-Door Shoppable

1.1× MedicareGood

Outpatient Surgery & ORBack-Door Captive

1.4× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

1.2× MedicareGood

Back-Door Captive ER VisitsBack-Door Captive

1.6× MedicareGood

Inpatient Lab & PathologyBack-Door Captive

1.5× MedicareGood

Specialty & Infusion Drugs (J-Codes)Back-Door Captive

1.3× MedicareGood

Self-Pay Cash Honesty & 501(r)Integrity & Outcomes

13% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

4 CMS · 66/100Fair

Procedure Prices at SSM St Clare Health Center

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 128 published procedures.

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Audit a Bill & 501(r) Cap ↓

Procedure & Billing Code	Self-Pay Cash	This Hospital	Fair BaseRate	vs. Fair
Spinal fusion, single level (inpatient stay) MS-DRG Code: `451`	—	$24,333	$30,775	0.8×
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	—	$15,061	$19,087	0.8×
Hip or knee replacement (inpatient stay) MS-DRG Code: `470`	—	$14,962	$19,432	0.8×
Heart stent placement (inpatient stay) MS-DRG Code: `322`	—	$13,748	$17,936	0.8×
Trauma team activation HCPCS Code: `G0390`	$7,329	$7,329	$1,453	5.0×
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	—	$6,630	$8,223	0.8×
Total hip replacement CPT Code: `27130`	—	$4,368	$13,413	0.3×
Total knee replacement CPT Code: `27447`	—	$4,368	$13,523	0.3×
C-section delivery (full package) CPT Code: `59510`	—	$3,957	$2,975	1.3×
Vaginal delivery (full package) CPT Code: `59400`	—	$3,829	$2,680	1.4×
Gallbladder removal (laparoscopic) CPT Code: `47562`	—	$3,594	$6,109	0.6×
Knee arthroscopy with meniscus repair CPT Code: `29881`	—	$2,510	$3,372	0.7×
Inguinal hernia repair CPT Code: `49505`	—	$2,484	$3,629	0.7×
Cataract surgery with lens implant CPT Code: `66984`	—	$2,340	$2,540	0.9×
Bunion correction surgery CPT Code: `28296`	—	$2,248	$3,446	0.7×
Breast lump removal CPT Code: `19120`	$3,502	$2,144	$3,875	0.6×
Injection procedure for pain management HCPCS Code: `G0260`	$3,218	$1,444	$855	1.7×
Colonoscopy with biopsy CPT Code: `45380`	—	$1,213	$1,256	1.0×
Colonoscopy (diagnostic) CPT Code: `45378`	—	$943	$981	1.0×
Sleep study (overnight, in lab) CPT Code: `95810`	$3,878	$882	$1,021	0.9×
Upper endoscopy with biopsy CPT Code: `43239`	$932	$810	$987	0.8×
MRI, brain (with and without contrast) CPT Code: `70553`	$2,359	$515	$511	1.0×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$2,309	$449	$448	1.0×
Echocardiogram (heart ultrasound) CPT Code: `93306`	$4,270	$467	$583	0.8×
Rabies immune globulin HCPCS Code: `90375`	—	$322	$322	1.0×
MRI, brain (no contrast) CPT Code: `70551`	$1,261	$313	$343	0.9×
MRI, lower back (no contrast) CPT Code: `72148`	$1,613	$304	$338	0.9×
MRI, knee or other leg joint CPT Code: `73721`	$1,695	$328	$369	0.9×
CT scan, head (with and without contrast) CPT Code: `70470`	$1,427	$251	$258	1.0×
Ultrasound, leg veins (duplex) CPT Code: `93970`	$1,780	$264	$272	1.0×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$2,038	$246	$303	0.8×
Diagnostic mammogram (both breasts) CPT Code: `77066`	$358	$213	$148	1.4×
CT scan, chest (no contrast) CPT Code: `71250`	$815	$214	$167	1.3×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$815	$214	$168	1.3×
CT scan, neck (cervical spine) CPT Code: `72125`	$815	$214	$169	1.3×
Psychotherapy session (60 minutes) CPT Code: `90837`	$235	$211	$181	1.2×
Psychiatric evaluation (first visit) CPT Code: `90791`	$250	$212	$185	1.1×
Neurobehavioral status check CPT Code: `96116`	—	$218	$231	0.9×
CT scan, head (with contrast) CPT Code: `70460`	$1,223	$220	$242	0.9×
Care planning with family CPT Code: `90887`	—	$174	$107	1.6×
Screening mammogram (both breasts) CPT Code: `77067`	$178	$176	$123	1.4×
CT scan, sinuses CPT Code: `70486`	$883	$191	$166	1.2×
Review of medical records for care CPT Code: `90889`	—	$165	$114	1.4×
Ultrasound, thyroid and neck CPT Code: `76536`	$526	$156	$132	1.2×
CT scan, pelvis CPT Code: `72192`	$815	$180	$163	1.1×
Psychotherapy session (45 minutes) CPT Code: `90834`	$159	$181	$166	1.1×
New patient office visit (30-44 min) CPT Code: `99203`	$142	$142	$110	1.3×
Hepatitis B immune globulin HCPCS Code: `90371`	—	$161	$151	1.1×
Family therapy session CPT Code: `90847`	$250	$184	$173	1.1×
Blood transfusion CPT Code: `36430`	$815	$179	$498	0.4×
Speech therapy (language evaluation) CPT Code: `92507`	$188	$127	$86	1.5×
Ultrasound, abdomen (complete) CPT Code: `76700`	$636	$146	$134	1.1×
Ultrasound, pelvis CPT Code: `76856`	$604	$134	$130	1.0×
Ultrasound, abdomen (limited) CPT Code: `76705`	$567	$126	$126	1.0×
CT scan, head (no contrast) CPT Code: `70450`	$1,019	$144	$160	0.9×
Office visit, established patient (30-39 min) CPT Code: `99214`	$150	$150	$123	unverified
X-ray, hip CPT Code: `73502`	$173	$87	$93	0.9×
X-ray, lower back CPT Code: `72110`	$358	$94	$112	0.8×
Psychological testing by technician CPT Code: `96138`	—	$110	$395	0.3×
Office visit, established patient (20-29 min) CPT Code: `99213`	$102	$102	$87	unverified
Typhoid vaccine HCPCS Code: `90675`	—	$373	$347	1.1×
Pneumococcal vaccine HCPCS Code: `90732`	—	$220	$140	1.6×
Varicella (chickenpox) vaccine HCPCS Code: `90716`	—	$200	$203	1.0×
Drug screening test HCPCS Code: `G0480`	$276	$133	$116	1.1×
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	—	$102	$111	0.9×
Blood test, ferritin (iron stores) CPT Code: `82728`	$53	$53	$14	3.8×
Occupational therapy (self-care training) CPT Code: `97535`	$75	$56	$38	1.5×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$85	$56	$40	1.4×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$101	$53	$38	1.4×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$81	$74	$56	1.3×
Flu vaccine (high dose) HCPCS Code: `90656`	$25	$37	$25	1.5×
Hepatitis B vaccine HCPCS Code: `90744`	—	$51	$37	1.4×
Orthotic fitting and training CPT Code: `97760`	$100	$61	$51	1.2×
Group therapy session CPT Code: `90853`	$179	$75	$100	0.8×
X-ray, ankle CPT Code: `73610`	$216	$64	$93	0.7×
X-ray, neck (cervical spine) CPT Code: `72040`	$283	$62	$93	0.7×
X-ray, hand CPT Code: `73130`	$206	$62	$93	0.7×
X-ray, foot CPT Code: `73630`	$216	$59	$92	0.6×
X-ray, chest (two views) CPT Code: `71046`	$202	$58	$93	0.6×
X-ray, shoulder CPT Code: `73030`	$223	$55	$92	0.6×
Psychological testing evaluation CPT Code: `96136`	—	$74	$128	0.6×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$38	$7	$3	2.3×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$46	$28	$14	2.0×
Electrocardiogram (ECG/EKG) CPT Code: `93000`	—	$38	$25	1.5×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$95	$52	$35	1.5×
Physical therapy (manual therapy) CPT Code: `97140`	$92	$48	$34	1.4×
Physical therapy (functional capacity test) CPT Code: `97750`	—	$53	$38	1.4×
Physical therapy (gait training) CPT Code: `97116`	$76	$45	$33	1.4×
Diagnostic procedure preparation HCPCS Code: `G0279`	—	$45	$35	1.3×
Prosthetic fitting and training CPT Code: `97761`	—	$53	$45	1.2×
Flu vaccine injection HCPCS Code: `G0008`	$76	$42	$48	0.9×
Pneumonia vaccine injection HCPCS Code: `G0009`	$76	$42	$49	0.9×
Colorectal cancer screening HCPCS Code: `G0010`	$83	$42	$49	0.9×
X-ray, pelvis CPT Code: `72170`	$184	$53	$110	0.5×
Breathing treatment (nebulizer) CPT Code: `94640`	$120	$53	$201	0.3×
Blood test, vitamin D CPT Code: `82306`	$83	$63	$31	unverified
Blood test, vitamin B12 CPT Code: `82607`	$48	$48	$16	unverified
Blood test, lipase CPT Code: `83690`	$68	$68	$7	unverified
Prostate cancer screening (blood test) HCPCS Code: `G0103`	$63	$63	$20	unverified
Electrical stimulation therapy HCPCS Code: `G0283`	$98	$22	$14	1.6×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$245	$24	$64	0.4×
Blood test, PSA (prostate screen) CPT Code: `84153`	$58	$39	$19	unverified
Extended office visit (prolonged) HCPCS Code: `G2212`	$39	$39	$33	unverified
Blood test, clotting time (PTT) CPT Code: `85730`	$34	$13	$6	2.2×
Speech therapy (group session) CPT Code: `92508`	$92	$38	$27	1.4×
Blood test, calcium CPT Code: `82310`	$32	$11	$5	2.2×
Blood test, creatinine (kidney) CPT Code: `82565`	$23	$11	$5	2.2×
Blood test, thyroid (TSH) CPT Code: `84443`	$50	$36	$18	unverified
Blood test, glucose (blood sugar) CPT Code: `82947`	$37	$8	$4	2.0×
Blood test, potassium CPT Code: `84132`	$28	$10	$5	2.0×
Blood test, sodium CPT Code: `84295`	$32	$10	$5	2.0×
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$45	$8	$4	2.0×
Blood test, clotting time (PT/INR) CPT Code: `85610`	$25	$8	$5	1.6×
DTaP vaccine (diphtheria, tetanus, pertussis) HCPCS Code: `90700`	—	$32	$39	0.8×
X-ray, chest (single view) CPT Code: `71045`	$139	$31	$92	0.3×
Blood antibody screen CPT Code: `86850`	$85	$15	$46	0.3×
Blood test, basic metabolic panel CPT Code: `80048`	$98	$18	$9	unverified
Blood test, comprehensive metabolic panel CPT Code: `80053`	$94	$22	$11	unverified
Blood test, liver function panel CPT Code: `80076`	$79	$17	$9	unverified
Blood test, amylase CPT Code: `82150`	$63	$14	$7	unverified
Blood test, average blood sugar (A1c) CPT Code: `83036`	$34	$34	$10	unverified
Hospital observation (per hour) HCPCS Code: `G0378`	$1	$1	$86	0.0×
Blood test, magnesium CPT Code: `83735`	$42	$14	$7	unverified
Blood test, hemoglobin CPT Code: `85018`	$21	$5	$3	unverified
Blood test, complete blood count (CBC) CPT Code: `85025`	$61	$17	$8	unverified
Hepatitis C antibody test CPT Code: `86803`	$58	$30	$15	unverified
Culture, blood CPT Code: `87040`	$136	$22	$11	unverified
Culture, bacterial CPT Code: `87070`	$136	$18	$9	unverified

Showing top 25 high-impact procedures of 128 total

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 17.7%

Audit a Bill or Quote at SSM St Clare Health Center (Zero PHI Required)

CMS CCN: 260081

CPT 451

Select Procedure to Audit:

Fair BaseRate™ $30,775

Medicare Rate $23,504

Self-Pay Cash Request Quote

Insurer Median $24,333

1. Amount on Your Bill or Quote ($) Pre-filled with SSM St Clare Health Center’s charged/list benchmark

2. Household Annual Income ($) Screened against 2026 HHS Federal Poverty Guidelines

3. Household Size (1–8) 2026 FPL: $15,650 + $5,500 per additional person

Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $10,342 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $10,342

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (17.7% of gross = $10,342).

Step 2 · Cash vs. Insurance Arbitrage Request Prompt-Pay Quote

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask SSM St Clare Health Center's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.

Step 3 · Fair BaseRate Target +$27,624 Above Fair BaseRate

Negotiate Toward $30,775 Fair BaseRate ($23,504 Medicare)

Your bill ($58,399) is $27,624 above the denoised Fair BaseRate ($30,775) and 2.5× the $23,504 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.

IRS Form 990 Schedule H & 26 U.S.C. § 501(r) 501(c)(3) Nonprofit Hospital

Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)

Free Care Eligibility BenchmarkUp to 200% FPL100% charity write-off income threshold

Discounted Care EligibilityUp to 400% FPLSliding-scale & AGB billing cap tier

Charity Care Share of ExpensesSee Schedule HNet community financial assistance reported

26 U.S.C. § 501(r)(5) AGB Benchmark Method: lookback_commercial_median

Hospital-Specific CMS HCRIS Benchmark (17.7% of gross charges)

Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.

Screen your household size, income, and itemized CPT codes against 2026 HHS Federal Poverty Guidelines: Calculate Your 501(r) Cap Above ↑

CMS Care Compare Public Quality Record

Clinical Quality, Patient Experience & Infection Benchmarks

CMS Overall3/5 Stars (3/5)

Safety Composite66/100

Would Recommend75%

Rated 9 or 10 (HCAHPS)74%

Median ER Wait198 min

Left ER Before Seen1%

30-Day Mortality vs U.S.better

Unplanned Readmissionsame

Hip/Knee Complication Rate4%

Healthcare-Associated Infections (CDC NHSN / CMS HAI)

1.00 SIR = National Predicted Baseline (Lower Is Safer)

Central-Line Bloodstream Infectionsame

C. diff Hospital-Onset Infectionbetter

Source: CMS Hospital Care Compare (514 completed HCAHPS patient surveys). Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.

Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

Regional Value & Quality Leader

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for SSM St Clare Health Center.

Price Index: 0.54× regional baseline

Quality: 71/100 CMS composite

Median Household Income$81,340U.S. Census ACS

Local Uninsured Share5.8%Regional ACS estimate

200% FPL (1 Person)$31,920Common free-care ceiling

400% FPL (Family of 4)$128,600Common AGB cap ceiling

45 CFR § 180 Primary-Source Lineage & Federal Verification VeriRate 91/100 · Verified CMS CCN 260081

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

Download Official Hospital MRF ↗ Verify on CMS Medicare.gov (CCN 260081) ↗ CMS HCRIS Cost Reports ↗

Published MRF Filedownload.aspx

Publication / Vintage2026-04-01 · 84.85 MB

Validated Rate Rows3,869 (CMS v3.0.0)

File Integrity Digestbdd4da083fd9fe0c97de…

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

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