How many shoppable procedure prices are published for Madison County Health Care System?

Madison County Health Care System in Winterset, IA currently has 108 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do Madison County Health Care System's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, Madison County Health Care System's median negotiated commercial rate is 1.5× the regionally adjusted fair BaseRate benchmark.

Hospital Profile Critical Access Hospital Government - Local 25 Beds · rural Updated: 2026-06-05

Madison County Health Care System

300 West Hutchings Street, Winterset, IA 50273 · 108 Priced Procedures · 91% Patient Recommendation

CMS Overall Rating No CMS Rating

High Markup · Shop Alternatives

1.51×vs. Fair Market Price

Typical commercial prices here are +51% above the fair benchmark (1.51×) even after accounting for local nurse/doctor wages and patient complexity.

64/100 · Caution

64/100Self-Pay Cash Beats Insurance 43% of the Time

File Completeness51

Price Logic46

Peer Alignment64

Clean Billing71

Real Cash Discount100

High-Markup · Check Safety

Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.

Behavioral Pricing FingerprintUpper-Quartile Spread · +64% Tail Jump

Wide Procedure Spread · Upper-Quartile Skew Pricer

Madison County Health Care System prices routine shoppable procedures at 2.3× Medicare (median 1.55× Fair BaseRate) while upper-quartile commercial rates jump +64% to 2.54× Fair BaseRate. Self-pay cash discounts and comparing specific CPT procedure codes before scheduling yield the strongest savings.

#58 of 87 in IA · 65th State Percentile#2,651 of 3,385 in U.S. · 78th National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Bottom-quartile procedures (Q25) price at 0.49× the peer BaseRate benchmark
Self-pay cash beats commercial insurance on 43% of shoppable procedures (99/100 Cash Honesty)
CMS clinical safety score (75/100 safety score) with 91% patient recommendation
Binding Good Faith Estimate rights under 45 CFR § 149.610 protect self-pay patients before scheduling

Watchout

Where You Can Get Burned (Markup Traps)

Even at low-cost facilities (1.51× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
Commercial insurance median sits at 1.55× Fair BaseRate (2.3× Medicare), so insured patients should always compare the self-pay cash price before paying.
Upper-quartile procedures (Q75 2.54×) jump +64% above the median procedure ratio (Q50 1.55×)
Consolidated metro market (HHI 4,157) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))

Front-Door ShoppableElective / Imaging

2.3× Medicare

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

Back-Door Captive & ER0.39× Divergence

0.9× Medicare

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

Quantile Tail Spread+64% Upper Tail

Q25 0.49× · Q50 1.55× · Q75 2.54×

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

2.3× MedicareFair

Outpatient Surgery & ORBack-Door Captive

0.8× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

2.9× MedicareFair

Back-Door Captive ER VisitsBack-Door Captive

0.6× MedicareGood

Inpatient Lab & PathologyBack-Door Captive

4.7× MedicareWatchout

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

1.2× MedicareGood

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

43% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

3 CMS · 75/100Fair

Procedure Prices at Madison County Health Care System

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 108 published procedures.

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Audit a Bill & 501(r) Cap ↓

Procedure & Billing Code	Self-Pay Cash	This Hospital	Fair BaseRate	vs. Fair
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	$15,918	$15,918	$19,087	0.8×
Total knee replacement CPT Code: `27447`	$2,725	$2,725	$13,523	0.2×
Trauma team activation HCPCS Code: `G0390`	$1,510	$1,510	$1,453	1.0×
MRI, brain (with and without contrast) CPT Code: `70553`	$5,090	$1,295	$511	2.5×
CT scan, head (with contrast) CPT Code: `70460`	$1,774	$1,094	$242	4.5×
CT scan, head (with and without contrast) CPT Code: `70470`	$1,921	$1,094	$258	4.2×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$2,640	$1,094	$303	3.6×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$3,195	$1,094	$448	2.4×
Gallbladder removal (laparoscopic) CPT Code: `47562`	$5,303	$1,075	$6,109	0.2×
CT scan, head (no contrast) CPT Code: `70450`	$1,494	$1,094	$160	unverified
MRI, lower back (no contrast) CPT Code: `72148`	$2,787	$1,032	$338	3.1×
MRI, brain (no contrast) CPT Code: `70551`	$2,796	$1,032	$343	3.0×
MRI, knee or other leg joint CPT Code: `73721`	$2,668	$1,032	$369	2.8×
Knee arthroscopy with meniscus repair CPT Code: `29881`	$3,396	$891	$3,372	0.3×
Bunion correction surgery CPT Code: `28296`	$4,802	$766	$3,446	0.2×
Inguinal hernia repair CPT Code: `49505`	$3,642	$727	$3,629	0.2×
Rabies immune globulin HCPCS Code: `90375`	$5,672	$613	$322	1.9×
Breast lump removal CPT Code: `19120`	$2,159	$575	$3,875	0.1×
CT scan, pelvis CPT Code: `72192`	$1,526	$505	$163	3.1×
CT scan, sinuses CPT Code: `70486`	$1,458	$505	$166	3.0×
CT scan, chest (no contrast) CPT Code: `71250`	$1,486	$505	$167	3.0×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$1,871	$505	$168	3.0×
CT scan, neck (cervical spine) CPT Code: `72125`	$1,766	$505	$169	3.0×
Echocardiogram (heart ultrasound) CPT Code: `93306`	$1,740	$436	$583	0.7×
Blood transfusion CPT Code: `36430`	$402	$402	$498	unverified
Colonoscopy with biopsy CPT Code: `45380`	$1,758	$375	$1,256	0.3×
Ultrasound, pelvis CPT Code: `76856`	$644	$318	$130	2.4×
Ultrasound, abdomen (complete) CPT Code: `76700`	$694	$318	$134	2.4×
Ultrasound, leg veins (duplex) CPT Code: `93970`	$899	$318	$272	1.2×
Colonoscopy (diagnostic) CPT Code: `45378`	$1,642	$329	$981	0.3×
Screening mammogram (both breasts) CPT Code: `77067`	$219	$232	$123	1.9×
Diagnostic mammogram (both breasts) CPT Code: `77066`	$248	$232	$148	1.6×
Upper endoscopy with biopsy CPT Code: `43239`	$1,598	$247	$987	0.3×
Speech therapy (group session) CPT Code: `92508`	$271	$271	$27	unverified
Office visit, established patient (30-39 min) CPT Code: `99214`	$274	$221	$123	unverified
X-ray, hand CPT Code: `73130`	$178	$178	$93	1.9×
New patient office visit (30-44 min) CPT Code: `99203`	$237	$195	$110	1.8×
Ultrasound, abdomen (limited) CPT Code: `76705`	$511	$201	$126	1.6×
Ultrasound, thyroid and neck CPT Code: `76536`	$430	$201	$132	1.5×
Psychotherapy session (45 minutes) CPT Code: `90834`	$340	$218	$166	1.3×
Psychotherapy session (60 minutes) CPT Code: `90837`	$360	$218	$181	1.2×
X-ray, ankle CPT Code: `73610`	$174	$174	$93	1.9×
X-ray, foot CPT Code: `73630`	$162	$162	$92	1.8×
Group therapy session CPT Code: `90853`	$314	$170	$100	1.7×
Office visit, established patient (20-29 min) CPT Code: `99213`	$183	$162	$87	unverified
Speech therapy (language evaluation) CPT Code: `92507`	$225	$135	$86	1.6×
Occupational therapy (self-care training) CPT Code: `97535`	$101	$127	$38	unverified
Physical therapy (gait training) CPT Code: `97116`	$101	$101	$33	3.1×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$99	$99	$35	2.8×
Physical therapy (functional capacity test) CPT Code: `97750`	$102	$102	$38	2.7×
X-ray, pelvis CPT Code: `72170`	$125	$125	$110	1.1×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$92	$92	$38	2.4×
Orthotic fitting and training CPT Code: `97760`	$95	$95	$51	1.9×
Family therapy session CPT Code: `90847`	$360	$85	$173	0.5×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$90	$90	$64	unverified
Breathing treatment (nebulizer) CPT Code: `94640`	$106	$106	$201	unverified
Physical therapy (manual therapy) CPT Code: `97140`	$105	$105	$34	unverified
Occupational therapy (therapeutic activities) CPT Code: `97530`	$93	$93	$40	unverified
Electrical stimulation therapy HCPCS Code: `G0283`	$85	$85	$14	unverified
Blood test, comprehensive metabolic panel CPT Code: `80053`	$238	$238	$11	21.6×
Culture, blood CPT Code: `87040`	$232	$232	$11	21.1×
Varicella (chickenpox) vaccine HCPCS Code: `90716`	$426	$218	$203	1.1×
Typhoid vaccine HCPCS Code: `90675`	$1,381	$218	$347	0.6×
Blood test, basic metabolic panel CPT Code: `80048`	$151	$151	$9	16.8×
Blood test, liver function panel CPT Code: `80076`	$150	$150	$9	16.7×
Blood test, lipase CPT Code: `83690`	$123	$123	$7	17.6×
Blood test, ferritin (iron stores) CPT Code: `82728`	$104	$104	$14	7.4×
Blood test, average blood sugar (A1c) CPT Code: `83036`	$78	$78	$10	7.8×
Blood test, vitamin B12 CPT Code: `82607`	$102	$102	$16	6.4×
Blood test, thyroid (TSH) CPT Code: `84443`	$113	$113	$18	6.3×
Blood test, amylase CPT Code: `82150`	$74	$74	$7	10.6×
Blood test, complete blood count (CBC) CPT Code: `85025`	$77	$77	$8	9.6×
Culture, bacterial CPT Code: `87070`	$65	$65	$9	7.2×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$89	$89	$14	6.4×
Hepatitis C antibody test CPT Code: `86803`	$85	$85	$15	5.7×
Blood test, PSA (prostate screen) CPT Code: `84153`	$100	$100	$19	5.3×
Prostate cancer screening (blood test) HCPCS Code: `G0103`	$100	$100	$20	5.0×
Blood test, vitamin D CPT Code: `82306`	$92	$92	$31	3.0×
Drug screening test HCPCS Code: `G0480`	$97	$108	$116	0.9×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$42	$42	$3	14.0×
Blood test, magnesium CPT Code: `83735`	$67	$67	$7	9.6×
Blood antibody screen CPT Code: `86850`	$80	$80	$46	1.7×
Blood test, hemoglobin CPT Code: `85018`	$38	$38	$3	12.7×
Blood test, clotting time (PTT) CPT Code: `85730`	$53	$53	$6	8.8×
Prosthetic fitting and training CPT Code: `97761`	$69	$69	$45	1.5×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$82	$65	$56	1.2×
X-ray, chest (single view) CPT Code: `71045`	$195	$62	$92	0.7×
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	$203	$65	$111	0.6×
Pneumococcal vaccine HCPCS Code: `90732`	$216	$68	$140	0.5×
Blood test, glucose (blood sugar) CPT Code: `82947`	$30	$30	$4	7.5×
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$27	$27	$4	6.8×
Blood test, creatinine (kidney) CPT Code: `82565`	$30	$30	$5	6.0×
Blood test, calcium CPT Code: `82310`	$27	$27	$5	5.4×
Blood test, potassium CPT Code: `84132`	$26	$26	$5	5.2×
Blood test, sodium CPT Code: `84295`	$24	$24	$5	4.8×
Flu vaccine (high dose) HCPCS Code: `90656`	$48	$48	$25	1.9×
Hepatitis B vaccine HCPCS Code: `90744`	$43	$43	$37	1.2×
DTaP vaccine (diphtheria, tetanus, pertussis) HCPCS Code: `90700`	$45	$45	$39	1.2×
Flu vaccine injection HCPCS Code: `G0008`	$16	$16	$48	0.3×
Electrocardiogram (ECG/EKG) CPT Code: `93000`	$32	$32	$25	unverified
Extended office visit (prolonged) HCPCS Code: `G2212`	$48	$48	$33	unverified
Blood test, clotting time (PT/INR) CPT Code: `85610`	$119	$4	$5	0.8×
Pneumonia vaccine injection HCPCS Code: `G0009`	$16	$16	$49	0.3×
X-ray, neck (cervical spine) CPT Code: `72040`	$186	$19	$93	0.2×
X-ray, lower back CPT Code: `72110`	$295	$22	$112	0.2×
X-ray, chest (two views) CPT Code: `71046`	$194	$18	$93	0.2×
X-ray, shoulder CPT Code: `73030`	$263	$16	$92	0.2×
Diagnostic procedure preparation HCPCS Code: `G0279`	$40	$40	$35	unverified

Showing top 25 high-impact procedures of 108 total

Inline Bill X-Ray & 501(r) Calculator For-Profit Facility · Cash & Fair BaseRate Audit

Audit a Bill or Quote at Madison County Health Care System (Zero PHI Required)

CMS CCN: 161326

CPT 871

Select Procedure to Audit:

Fair BaseRate™ $19,087

Medicare Rate $14,117

Self-Pay Cash $15,918

Insurer Median $15,918

1. Amount on Your Bill or Quote ($) Pre-filled with Madison County Health Care System’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 274% of 2026 FPL

Above Standard 400% FPL Financial-Assistance Ceiling

At 274% FPL, you exceed the standard 400% FPL tier, though medical-hardship caps (when bills exceed 10% of annual income) may still apply.

Step 2 · Cash vs. Insurance Arbitrage Save $3,980 Paying Cash

Self-Pay Cash Rate ($15,918) Beats Your Bill

Madison County Health Care System's published 45 CFR § 180 self-pay cash rate is $15,918 (vs. $15,918 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$811 Above Fair BaseRate

Negotiate Toward $19,087 Fair BaseRate ($14,117 Medicare)

Your bill ($19,898) is $811 above the denoised Fair BaseRate ($19,087) and 1.4× the $14,117 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) For-Profit / Non-501(c)(3)

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

Public IRS & CMS ownership records classify Madison County Health Care System as a non-501(c)(3) facility. Federal 26 U.S.C. § 501(r) statutory charity-care caps apply specifically to tax-exempt nonprofit hospitals, though state hospital fair-pricing statutes and prompt-pay self-pay discounts may still apply.

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

Safety Composite75/100

Would Recommend91%

Rated 9 or 10 (HCAHPS)95%

Median ER Wait113 min

Left ER Before Seen1%

30-Day Mortality vs U.S.same

Unplanned Readmissionsame

CMS Price Transparency Administrative Enforcement Log

Factual public administrative actions published by the Centers for Medicare & Medicaid Services regarding 45 CFR § 180 compliance at Madison County Health Care System. Prior administrative notices do not necessarily reflect current compliance status.

2025-07-11·administrative_or_closure
Met Requirements
Recorded
2024-04-03·administrative_or_closure
Met Requirements
Recorded
2023-12-04·administrative_or_closure
Met Requirements
Recorded

Source: CMS Hospital Care Compare (71 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 Madison County Health Care System.

Price Index: 1.00× regional baseline

Quality: 60/100 CMS composite

Median Household Income$89,542U.S. Census ACS

Local Uninsured Share4.9%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 64/100 · Caution CMS CCN 161326

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

MRF Portal Indexed (CMS_45_CFR_180_FILING.json) Verify on CMS Medicare.gov (CCN 161326) ↗ CMS HCRIS Cost Reports ↗

Published MRF FileCMS_45_CFR_180_FILING.json

Publication / Vintage2026-06-05

Validated Rate Rows2,465 (CMS v3.0.0)

File Integrity DigestVerified · CCN 161326

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.

Submit MRF Update Correction Policy