Biopsy of lip 40490 at SSM Health St. Joseph Hospital - Lake Saint Louis
100 Medical Plaza, Lake Saint Louis, MO · SSM Health · · NPI 1871665380
$91.51
Cash price Discounted cash price What a hospital charges a self-pay patient who pays directly, without going through insurance — usually well below the gross charge. Example: A CT scan has a $3,200 gross charge but an $850 discounted cash price. Ask for it by name when scheduling — hospitals don't always advertise it up front.
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What you pay up front if you don't use insurance.
$166.39
Gross charge Gross charge (chargemaster price) The hospital's full, undiscounted list price — pulled from its internal "chargemaster" price list. Almost no one actually pays this. Example: A chest X-ray has a gross charge of $1,450. The same hospital's discounted cash price for the same X-ray is $180 — the gross charge mostly anchors negotiations, not what patients pay.
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The hospital's undiscounted list price — almost no one pays this.
$78.09 with BCBS vs $4,261.00 with Aetna — same scan, same building. Share
Negotiated rates by payer
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →Payer ?Payer The insurance company footing the bill — Aetna, UnitedHealthcare, Medicare, and so on. Example: "Blue Cross Blue Shield" is the payer. Its negotiated rate for an MRI might be $904, while a different payer's negotiated rate for the same scan is $1,509. Full explanation → |
Plan ?Plan The specific product an insurer sells — e.g. "Blue Cross PPO 500" — which sets your deductible, coinsurance and negotiated rates. Example: Two people both insured by Aetna can owe very different amounts for the same MRI: $50 with an HMO plan's flat copay, or the full $1,200 toward a high-deductible PPO plan's unmet deductible. Full explanation → |
Negotiated rate | vs. cash |
|---|---|---|---|
| BCBS | Anthem Pathway Exchange | $78.09 | ↓ -15% |
| BCBS | Anthem Blue Access Choice PPO | $80.25 | ↓ -12% |
| BCBS | Anthem Blue Preferred HMO/POS | $80.63 | ↓ -12% |
| BCBS | Anthem Blue Access PPO | $86.96 | ↓ -5% |
| Aetna | Medicare Managed Care Plan | $237.23 | ↑ +159% |
| Aetna | Gold Advantage Medicare Managed Care Plan | $239.60 | ↑ +162% |
| UnitedHealthCare | Medicare Managed Care Plan | $240.74 | ↑ +163% |
| BCBS | Anthem Medicare Managed Care Plan | $240.79 | ↑ +163% |
| Humana | Medicare Managed Care Plan | $241.27 | ↑ +164% |
| Aetna | Advantra Medicare Managed Care Plan | $245.54 | ↑ +168% |
| Cigna | OAP Other Commercial Plan | $279.00 | ↑ +205% |
| Oscar | Exchange | $284.68 | ↑ +211% |
| UnitedHealthCare | St. Louis University Employee | $541.00 | ↑ +491% |
| UnitedHealthCare | All Commercial Plans | $719.00 | ↑ +686% |
| UnitedHealthCare | Options PPO | $932.00 | ↑ +918% |
| Ambetter | Exchange | $2,167.00 | ↑ +2268% |
| Healthlink | Employers Choice All Commercial Plans | $2,302.00 | ↑ +2416% |
| Aetna | Carelink Other Commercial Plan | $2,444.00 | ↑ +2571% |
| Aetna | NBD Other Commercial Plan | $3,760.00 | ↑ +4009% |
| Healthlink | HMO | $3,829.00 | ↑ +4084% |
| Aetna | All Commercial Plans | $4,261.00 | ↑ +4556% |
Visitor-reported prices
Comments
Biopsy of lip 40490 at other Missouri hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| SSM Health DePaul Hospital - St. Louis | Bridgeton | $91.51 | $78.09 – $2,302.00 |
| SSM Health Saint Louis University Hospital | Saint Louis | $398.75 | $89.67 – $3,085.00 |
| SSM Health St. Joseph Hospital- Wentzville | Wentzville | $91.51 | $78.09 – $2,444.00 |
| SSM Health St. Joseph Hospital - St. Charles | Saint Charles | $91.51 | $78.09 – $2,302.00 |
| SSM Health St. Mary's Hospital - St. Louis | Richmond Heights | $91.51 | $78.09 – $2,302.00 |
| Mercy Hospital Lincoln | Troy | $54.60 | $197.97 – $304.87 |
| Mercy Hospital Southeast | Cape Girardeau | $54.60 | $53.27 – $1,522.08 |
| SSM Health St. Clare Hospital - Fenton | Fenton | $91.51 | $78.09 – $2,302.00 |