CMS Price Transparency Data
Hospital file updated: 2026-03-31
Sleep study (overnight, in lab)
Facility: Saint Joseph Regional Medical Center
Billing Code: 95810 (CPT)
Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.High Markup · Shop Alternatives
$464Fair BaseRate (3.89× Market)
Position vs. 1.00× Fair Price+289% Above Fair Price
1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.
This hospital's typical commercial price is $1,805 compared to the $464 fair price benchmark.
Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).86/100 · Verified
86/100Hover Any Check Below to See How Prices Were Audited
File Completeness90Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic88Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment86Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing83Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount84Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.High Price · Lower Safety
CMS Star Rating2/5 StarsOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety Score42/100Composite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER WaitNo ER DataMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.
2-Star CMS clinical quality rating paired with 3.89× fair market pricing.
The BaseRate · fair price low confidence
A fair price for this
$464
about 0.5× the $877 Medicare rate · typically $140–$1,336
modeled estimate · not a bill or quote
Medicare pays $877 Fair price $464 Cash price $1,805 Hospital's list price $2,704
What each insurance company pays
Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.
6 of 6 major insurers have a published price at this hospital
UnitedHealthcareBlue Cross Blue ShieldAetnaCignaHumanaKaiser Permanente
Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.
| Insurance company | Price range | vs. Medicare |
|---|---|---|
| UnitedHealthcaremajor | $109 - $3,560 | 12% |
| Blue Cross Blue Shieldmajor | $109 - $3,560 | 12% |
| Aetnamajor | $109 - $3,340 | 12% |
| Cignamajor | $109 - $3,288 | 12% |
| Humanamajor | $109 - $113 | 12% |
| Kaiser Permanentemajor | $140 | 16% |
| Ambetter (Centene) | $109 | 12% |
| CareSource | $150 - $1,408 | 17% |
| Clover Health | $113 | 13% |
| GEHA | $205 - $3,273 | 23% |
| Health Net | $109 - $3,802 | 12% |
| HealthPartners | $109 - $3,288 | 12% |
| Medical Mutual | $3,340 | 381% |
| Meridian | $109 - $909 | 12% |
| Molina | $109 | 12% |
| MVP Health Care | $3,288 | 375% |
| Paramount | $109 | 12% |
| Presbyterian | $109 - $113 | 12% |
| Priority Health | $3,288 | 375% |
| Tufts Health Plan | $109 | 12% |
| WellMed | $113 | 13% |
| WellSense | $109 | 12% |
| + 367 smaller / regional plans | $109 - $5,138 |
Government programs also on file: Medicare, Medicaid, Military & VA.
Excludes 11 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.
Self-Pay How to get the cash price
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Other Procedures at Saint Joseph Regional Medical Center
Compare: Sleep study (overnight, in lab) at other IN hospitals
- Dukes Memorial Hospital · Peru $316
- Daviess Community Hospital · Washington $393
- Ascension St Vincent Evansville · Evansville $443
- Ascension St Vincent Randolph · Winchester $443
- Ascension St Vincent Kokomo · Kokomo $466
- Ascension St Vincent Anderson · Anderson $466
- St Vincent Heart Center · Carmel $466
- Ascension St Vincent Carmel · Carmel $466
Insurance negotiated median for the same procedure, sorted lowest first.
Inline Bill X-Ray & 501(r) Calculator
501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 36.3%
Audit a Bill or Quote at Saint Joseph Regional Medical Center (Zero PHI Required)
CMS CCN: 150012
CPT 95810
Fair BaseRate™ $464
Medicare Rate $877
Self-Pay Cash $1,805
Insurer Median $534
Pre-filled with Saint Joseph Regional Medical Center’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check
501(r) AGB Cap: $982 (274% FPL)
Statutory 501(r) AGB Cap Limits Bill to $982
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $982).
Step 2 · Cash vs. Insurance Arbitrage
Save $899 Paying Cash
Self-Pay Cash Rate ($1,805) Beats Your Bill
Saint Joseph Regional Medical Center's published 45 CFR § 180 self-pay cash rate is $1,805 (vs. $534 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.
Step 3 · Fair BaseRate Target
+$2,240 Above Fair BaseRate
Negotiate Toward $464 Fair BaseRate ($877 Medicare)
Your bill ($2,704) is $2,240 above the denoised Fair BaseRate ($464) and 3.1× the $877 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.
CMS Care Compare Public Quality Record
Clinical Quality, Patient Experience & Infection Benchmarks
CMS Overall2/5 Stars (2/5)
Source: CMS Hospital Care Compare. 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
45 CFR § 180 Primary-Source Lineage & Federal Verification
Verified
CMS CCN 150012
Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings
MRF Portal Indexed (350868157_mishawaka-medical-center_standardcharges.zip!350868157_Mishawaka-Medical-Center_standardcharges.csv)
Verify on CMS Medicare.gov (CCN 150012) ↗
CMS HCRIS Cost Reports ↗
Published MRF File350868157_mishawaka-medical-center_standardcharges.zip!350868157_Mishawaka-Medical-Center_standardcharges.csv
Publication / Vintage2026-03-31 · 138.23 MB
Validated Rate Rows13,208,302 (CMS v3.0.0)
File Integrity Digest3c9e62c80fcee154035d…
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.