Cost-conscious consumers have always known comparison shopping is the best way to stretch a dollar.

But shopping for the best health-care bargain is a little trickier than finding the lowest price on a new computer, experts warn.

The Missouri Department of Health's 1996 Buyer's Guides on outpatient procedures show Southeast Missouri median prices generally are lower than the statewide median and St. Louis median charges for those procedures.

Of 12 procedures picked at random, Southeast Missouri was lower than the state median for six, higher for five and equal on one procedure, a screening mammogram.

Charges tended to be higher in Southeast Missouri for diagnostic procedures. The region's median price for an upper GI endoscopy -- viewing the upper gastrointestinal tract with a scope -- was $934, 21.14 percent higher than the state median charge of $771. That was the highest price differential.

Charges for surgical procedures tended to be lower in Southeast Missouri than the statewide median. The median charge for stripping and ligation of varicose veins was listed as $2,410 in the region, 18.1 percent below the statewide median of $2,943.

Southeast Missouri's median prices were below the St. Louis area's median prices for 10 of those 12 procedures, a fact that may surprise some consumers.

Overall, the lowest median charges were listed in the Southwest Missouri region, where median prices for nine of those 12 procedures were below the state median charge.

Kansas City and St. Louis had the highest median charges for most procedures -- 38 percent and 34 percent, respectively. Southeast Missouri's median charges were the highest for only 2 percent of the procedures overall.

Cost shouldn't be the only guideline in deciding where to have a medical procedure performed, said Garland Land, director of the state's Center for Health Information.

"I think that they need to consider the reputation of the facility, the surgery that's involved, the number of procedures that have been performed there, what travel distance is involved, if any, all kinds of things," Land said.

Comparison shopping is a new concept in health care, he said.

"Health care is about the only commodity that we buy that we didn't know the price of ahead of time," he said. "You don't buy a car without knowing how much it costs. And we have found that price is indeed a real factor to a lot of people."

Overall, he said, ambulatory surgery centers tend to have lower charges than hospitals. But ambulatory surgery centers also tend to have lower overhead costs -- facilities, equipment, salaries and bad debt or uncompensated care costs, he said, and hospitals in urban areas tend to treat more trauma patients, who need more intensive care.

The Buyers Guides list the median charge for procedures assessed by each hospital or ambulatory surgical center in a region.

But the charges listed can be misleading, some say, depending on exactly what the charge includes.

"Those numbers are apples and oranges," said Michael Jones, chief operating officer of the Missouri Surgery Center, an ambulatory surgery center in Cape Girardeau.

The prices the hospitals quote, Jones said, "is the surgery price, not the pre-admission screenings, the lab work, the doctors."

James Wente, administrator of Southeast Missouri Hospital, said the charges quoted in the Buyers Guides are "the whole shooting match, except for the doctor."

Jones also said hospitals, which perform a wider range of services, can more easily manipulate their cost structures.

"It would be very easy for a hospital to set up a loss leader in that book to bring people in," he said. "When you're only doing 20 carpal tunnel releases a year versus 10,000, you can do that."

Jones said he spent 15 years as a hospital administrator in Michigan, where a publication compared hospital room rates.

"No one pays attention to room rates. We just lowered our room rates and upped pharmacy or upped labs. When you looked at room rates, Michigan had the cheapest health care in the nation," he said.

Wente pointed out that not every patient will pay the charge listed for a specific procedure. Some patients will need more follow-up care and some patients may need more intensive care in the operating room.

"What it basically comes down to is time," he said.

The cost of health care doesn't always come down to the charge for a specific procedure. Employers have to pay insurance premiums to provide employees with health insurance. Consumers have to pay deductibles and co-payments if they have insurance, or foot the full bill if they don't.

And insurance companies, even if they cover 100 percent of a given procedure, don't pay the full charge listed in the Buyers Guides, said Jeff Andersen, associate executive director of Humana Health Care in Cape Girardeau. Most insurance companies have negotiated set prices for different procedures.

Andersen said many of the local companies Humana covers send their employees to St. Louis hospitals because Humana covers more of the costs for procedures at those hospitals.

Wente said health care costs often come down to insurance contracts "and who the best negotiator is."

The Buyers Guides also list which facilities have consistently high or low charges for different types of procedures.

In Southeast Missouri, St. Francis Medical Center and Southeast Missouri Hospital are listed for consistently low charges in five and six procedure groups, respectively. Southeast Missouri Hospital is ranked consistently high for gynecological and breast procedures, and the hospital is looking at ways to reduce charges in those areas, Wente said.

St. Francis is not listed as consistently high in any of the procedural groups.

Doctors Park Surgery is listed as consistently low for charges in eight procedures.

Ron Wittmer, president of Doctors Park Surgery, said the Buyers Guides have made health care professionals more competitive.

"I think that we're looking at charges, and since the state Buyers Guides came out, I think that everybody's become a lot aware of charges, and I think the facilities that had consistently high charges have come much more into line with the others," he said.

Consumers may be surprised to learn that charges for medical procedures in Southeast Missouri are competitive with, or in many cases lower than, costs statewide and in the St. Louis area. Here are examples of costs at facilities in Cape Girardeau compared to St. Louis and the statewide median from the Missouri Department of Health's 1996 Buyer's Guide for outpatient procedures.

Cataract removal with lens insertion

Cape Girardeau OP Surgery Ctr. $1600

Doctors Park Surgery $1945

Missouri Surgery Ctr. NP

Southeast Missouri Hospital $1900

St. Francis Medical Center $2482

St. Louis median $3395

State median $2882

Region low: $1333

(Doctors Regional Medical Ctr., Poplar Bluff)

Screening mammography

Cape Girardeau OP Surgery Ctr. NP

Doctors Park Surgery NP

Missouri Surgery Ctr. NP

Southeast Missouri Hospital $45

St. Francis Medical Center $42

St. Louis median $62

State median $60

Region low: $29

(Lucy Lee Hospital, Poplar Bluff)

Tubal ligation

Cape Girardeau OP Surgery Ctr. NP

Doctors Park Surgery $1455

Missouri Surgery Ctr. $2450

Southeast Missouri Hospital $2713

St. Francis Medical Center NP

St. Louis median $3053

State median $2569

Region low: $1455

Gallbladder removal

Cape Girardeau OP Surgery Ctr. NP

Doctors Park Surgery $3500

Missouri Surgery Ctr. NP

Southeast Missouri Hospital $5313

St. Francis Medical Center $4795

St. Louis median $5892

State median $5758

Region low: $3500

Surgery for recurrent ear infections

Cape Girardeau OP Surgery Ctr. NP

Doctors Park Surgery $1010

Missouri Surgery Ctr. NP

Southeast Missouri Hospital $1565

St. Francis Medical Center $1203

St. Louis median $1500

State median $1400

Region low: $1008

(Missouri Delta Medical Ctr., Sikeston)

Removal of knot/swelling on hand/wrist

Cape Girardeau OP Surgery Ctr. NP

Doctors Park Surgery $1265

Missouri Surgery Ctr. $2070

Southeast Missouri Hospital $996

St. Francis Medical Center NP

St. Louis median $2107

State median $1800

Region low: $996

Viewing upper GI tract with a scope

Cape Girardeau OP Surgery Ctr. NP

Doctors Park Surgery $475

Missouri Surgery Ctr. NP

Southeast Missouri Hospital $500

St. Francis Medical Center $521

St. Louis median $929

State median $771

Region low: $475

Carpal Tunnel release

Cape Girardeau OP Surgery Ctr. NP

Doctors Park Surgery $980

Missouri Surgery Ctr. $1860

Southeast Missouri Hospital $1000

St. Francis Medical Center $800

St. Louis median $2181

State median $1831

Region low: $800

Varicose vein stripping and ligation

Cape Girardeau OP Surgery Ctr. NP

Doctors Park Surgery $1265

Missouri Surgery Ctr. NP

Southeast Missouri Hospital $2410

St. Francis Medical Center NP

St. Louis median $3227

State median $2943

Region low: $990

(Lucy Lee Hospital, Poplar Bluff)

CT Scan of the head without contrast dye

Cape Girardeau OP Surgery Ctr. NP

Doctors Park Surgery NP

Missouri Surgery Ctr. NP

Southeast Missouri Hospital $414

St. Francis Medical Center $523

St. Louis median $560

State median $587

Region low: $390

(Doctors Regional Medical Ctr., Poplar Bluff)

MRI scan of the spinal canal, w/wo contrast

Cape Girardeau OP Surgery Ctr. NP

Doctors Park Surgery NP

Missouri Surgery Ctr. NP

Southeast Missouri Hospital $1096

St. Francis Medical Center $962

St. Louis median $1267

State median $1125

Region low: $643

(Lucy Lee Hospital, Poplar Bluff)

Diagnostic ultrasound during pregnancy

Cape Girardeau OP Surgery Ctr. NP

Doctors Park Surgery NP

Missouri Surgery Ctr. NP

Southeast Missouri Hospital $192

St. Francis Medical Center $262

St. Louis median $240

State median $225

Region low: $176

(Doctors Regional Medical Ctr., Poplar Bluff)