How many shoppable procedure prices are published for Saint Joseph Regional Medical Center?

Saint Joseph Regional Medical Center in Mishawaka, IN currently has 119 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do Saint Joseph Regional Medical Center's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, Saint Joseph Regional Medical Center's median negotiated commercial rate is 1.4× the regionally adjusted fair BaseRate benchmark.

What is Saint Joseph Regional Medical Center's CMS Care Compare overall star rating?

CMS Care Compare assigns Saint Joseph Regional Medical Center an overall hospital quality rating of 2 out of 5 stars based on public federal clinical and patient-experience measures.

Hospital Profile Acute Care Hospital Voluntary non-profit - Private 253 Beds · rural Updated: 2026-03-31

Saint Joseph Regional Medical Center

5215 Holy Cross Pkwy, Mishawaka, IN 46545 · 119 Priced Procedures · 67% Patient Recommendation

CMS Overall Rating 2 / 5 Stars

Above Fair Market · Negotiate

1.37×vs. Fair Market Price

Typical commercial prices here are +37% above the fair benchmark (1.37×) even after accounting for local nurse/doctor wages and patient complexity.

68/100 · Caution

68/100Self-Pay Cash Beats Insurance 19% of the Time

File Completeness66

Price Logic63

Peer Alignment71

Clean Billing63

Real Cash Discount81

High-Markup · Check Safety

3-Star CMS clinical quality rating paired with 1.37× fair market pricing.

Behavioral Pricing FingerprintHigh-HHI Market Leverage

Consolidated System Premium Pricer

Operating in a concentrated regional market (CBSA HHI 4,758), Saint Joseph Regional Medical Center commands a 1.37× BaseRate commercial premium across insurers. Self-pay cash quotes, in-state peer hospitals, and freestanding outpatient facilities offer critical leverage against consolidated system pricing.

#64 of 107 in IN · 58th State Percentile#2,395 of 3,385 in U.S. · 70th National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Bottom-quartile procedures (Q25) price at 0.97× the peer BaseRate benchmark
Self-pay cash beats commercial insurance on 19% of shoppable procedures (81/100 Cash Honesty)
2-Star CMS clinical rating with 67% patient recommendation (63/100 safety score)
IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (33.9% AGB cap)

Watchout

Where You Can Get Burned (Markup Traps)

Even at low-cost facilities (1.37× 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.
Captive ER (2.0×) & laboratory (3.4×) services average 1.21× higher multiples than routine shoppable care (1.4×)
Even at low-cost facilities (1.37× 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.
Consolidated metro market (HHI 4,758) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))

Front-Door ShoppableElective / Imaging

1.4× Medicare

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

Back-Door Captive & ER1.21× Divergence

1.7× Medicare

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

Quantile Tail Spread+9% Upper Tail

Q25 0.97× · Q50 1.41× · Q75 1.54×

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

1.4× MedicareGood

Outpatient Surgery & ORBack-Door Captive

0.5× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

1.9× MedicareGood

Back-Door Captive ER VisitsBack-Door Captive

2.0× MedicareGood

Inpatient Lab & PathologyBack-Door Captive

3.4× MedicareElevated

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

0.7× MedicareGood

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

19% Cash Edge · 81/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

2 CMS · 63/100Elevated

Procedure Prices at Saint Joseph Regional Medical Center

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 119 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`	$58,091	$60,735	$30,775	unverified
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	$31,451	$36,898	$19,087	1.9×
Hip or knee replacement (inpatient stay) MS-DRG Code: `470`	$48,297	$36,646	$19,432	1.9×
Heart stent placement (inpatient stay) MS-DRG Code: `322`	$49,602	$33,146	$17,936	1.8×
Total knee replacement CPT Code: `27447`	$40,740	$25,809	$13,523	1.9×
Total hip replacement CPT Code: `27130`	$40,606	$25,809	$13,413	unverified
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	$16,156	$15,758	$8,223	1.9×
Gallbladder removal (laparoscopic) CPT Code: `47562`	$30,772	$9,914	$6,109	1.6×
Breast lump removal CPT Code: `19120`	$13,383	$6,421	$3,875	1.7×
Knee arthroscopy with meniscus repair CPT Code: `29881`	$18,163	$5,366	$3,372	1.6×
Bunion correction surgery CPT Code: `28296`	$20,113	$5,193	$3,446	1.5×
Cataract surgery with lens implant CPT Code: `66984`	$9,667	$4,316	$2,540	1.7×
Inguinal hernia repair CPT Code: `49505`	—	—	$3,629	—
Colonoscopy with biopsy CPT Code: `45380`	$6,788	$1,931	$1,256	1.5×
Sleep study (overnight, in lab) CPT Code: `95810`	$1,805	$1,805	$1,021	1.8×
Colonoscopy (diagnostic) CPT Code: `45378`	$6,286	$1,525	$981	1.6×
Vaginal delivery (full package) CPT Code: `59400`	—	$994	$2,680	0.4×
C-section delivery (full package) CPT Code: `59510`	$3,455	$762	$2,975	0.3×
Blood transfusion CPT Code: `36430`	—	$676	$498	1.4×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$4,243	$632	$448	1.4×
Rabies immune globulin HCPCS Code: `90375`	$2,089	$602	$322	1.9×
MRI, brain (with and without contrast) CPT Code: `70553`	$3,763	$563	$511	1.1×
MRI, lower back (no contrast) CPT Code: `72148`	$3,026	$404	$338	1.2×
MRI, brain (no contrast) CPT Code: `70551`	$2,678	$404	$343	1.2×
CT scan, head (with and without contrast) CPT Code: `70470`	$2,534	$378	$258	1.5×
CT scan, head (with contrast) CPT Code: `70460`	$2,026	$306	$242	1.3×
Injection procedure for pain management HCPCS Code: `G0260`	$2,198	$286	$855	0.3×
CT scan, pelvis CPT Code: `72192`	$1,949	$238	$163	1.5×
CT scan, sinuses CPT Code: `70486`	$1,773	$238	$166	1.4×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$2,060	$238	$168	1.4×
CT scan, neck (cervical spine) CPT Code: `72125`	$2,077	$238	$169	1.4×
MRI, knee or other leg joint CPT Code: `73721`	$4,455	$252	$369	0.7×
Ultrasound, pelvis CPT Code: `76856`	$1,152	$210	$130	1.6×
Ultrasound, thyroid and neck CPT Code: `76536`	$658	$210	$132	1.6×
Ultrasound, abdomen (complete) CPT Code: `76700`	$1,016	$210	$134	1.6×
CT scan, head (no contrast) CPT Code: `70450`	$1,480	$221	$160	1.4×
Diagnostic mammogram (both breasts) CPT Code: `77066`	$492	$204	$148	1.4×
X-ray, chest (two views) CPT Code: `71046`	$317	$175	$93	1.9×
Hospital observation (per hour) HCPCS Code: `G0378`	$171	$154	$86	1.8×
X-ray, pelvis CPT Code: `72170`	$284	$169	$110	1.5×
X-ray, lower back CPT Code: `72110`	$556	$171	$112	1.5×
Screening mammogram (both breasts) CPT Code: `77067`	$278	$169	$123	1.4×
Psychiatric evaluation (first visit) CPT Code: `90791`	$364	$166	$185	0.9×
Psychotherapy session (60 minutes) CPT Code: `90837`	$336	$160	$181	0.9×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	—	$169	$303	0.6×
X-ray, foot CPT Code: `73630`	$405	$143	$92	1.6×
X-ray, hand CPT Code: `73130`	$410	$143	$93	1.5×
X-ray, hip CPT Code: `73502`	$495	$143	$93	1.5×
X-ray, ankle CPT Code: `73610`	$488	$143	$93	1.5×
Echocardiogram (heart ultrasound) CPT Code: `93306`	$163	$163	$583	0.3×
Upper endoscopy with biopsy CPT Code: `43239`	—	$166	$987	0.2×
X-ray, shoulder CPT Code: `73030`	$452	$140	$92	1.5×
X-ray, neck (cervical spine) CPT Code: `72040`	$354	$140	$93	1.5×
Speech therapy (language evaluation) CPT Code: `92507`	$385	$118	$86	1.4×
New patient office visit (30-44 min) CPT Code: `99203`	$242	$108	$110	1.0×
CT scan, chest (no contrast) CPT Code: `71250`	$315	$122	$167	0.7×
Office visit, established patient (20-29 min) CPT Code: `99213`	—	$84	$87	1.0×
Psychotherapy session (45 minutes) CPT Code: `90834`	$227	$109	$166	0.7×
Ultrasound, leg veins (duplex) CPT Code: `93970`	$81	$81	$272	0.3×
X-ray, chest (single view) CPT Code: `71045`	—	—	$92	unverified
Office visit, established patient (30-39 min) CPT Code: `99214`	—	$100	$123	unverified
Typhoid vaccine HCPCS Code: `90675`	$1,351	$512	$347	1.5×
Varicella (chickenpox) vaccine HCPCS Code: `90716`	$456	$201	$203	1.0×
Drug screening test HCPCS Code: `G0480`	—	$145	$116	1.3×
Blood antibody screen CPT Code: `86850`	$163	$163	$46	unverified
Pneumococcal vaccine HCPCS Code: `90732`	$314	$131	$140	0.9×
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	$215	$98	$111	0.9×
Physical therapy (functional capacity test) CPT Code: `97750`	$103	$60	$38	1.6×
Prosthetic fitting and training CPT Code: `97761`	$113	$62	$45	1.4×
Orthotic fitting and training CPT Code: `97760`	$137	$70	$51	1.4×
Ultrasound, abdomen (limited) CPT Code: `76705`	—	$78	$126	0.6×
Electrical stimulation therapy HCPCS Code: `G0283`	$144	$24	$14	1.7×
Prostate cancer screening (blood test) HCPCS Code: `G0103`	$168	$29	$20	1.4×
Speech therapy (group session) CPT Code: `92508`	$31	$37	$27	1.4×
Physical therapy (gait training) CPT Code: `97116`	$113	$45	$33	1.4×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	—	$51	$38	1.3×
Occupational therapy (self-care training) CPT Code: `97535`	$107	$50	$38	1.3×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$76	$45	$35	1.3×
Physical therapy (manual therapy) CPT Code: `97140`	$141	$43	$34	1.3×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$114	$40	$56	0.7×
Breathing treatment (nebulizer) CPT Code: `94640`	$57	$57	$201	0.3×
Blood test, vitamin D CPT Code: `82306`	$214	$44	$31	unverified
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	—	—	$64	—
Occupational therapy (therapeutic activities) CPT Code: `97530`	—	$67	$40	unverified
Urinalysis (automated, with microscopy) CPT Code: `81001`	—	$6	$3	2.0×
Blood test, potassium CPT Code: `84132`	—	$10	$5	2.0×
Blood test, clotting time (PTT) CPT Code: `85730`	—	$12	$6	2.0×
Blood test, calcium CPT Code: `82310`	$60	$8	$5	1.6×
Blood test, creatinine (kidney) CPT Code: `82565`	$70	$8	$5	1.6×
Blood test, glucose (blood sugar) CPT Code: `82947`	$49	$6	$4	1.5×
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$49	$6	$4	1.5×
Blood test, complete blood count (CBC) CPT Code: `85025`	$113	$12	$8	1.5×
Blood test, PSA (prostate screen) CPT Code: `84153`	$161	$28	$19	1.5×
Blood test, comprehensive metabolic panel CPT Code: `80053`	$156	$16	$11	1.5×
Blood test, vitamin B12 CPT Code: `82607`	$196	$23	$16	1.4×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$226	$20	$14	1.4×
Blood test, amylase CPT Code: `82150`	$115	$10	$7	1.4×
Blood test, ferritin (iron stores) CPT Code: `82728`	$151	$20	$14	1.4×
Blood test, lipase CPT Code: `83690`	$103	$10	$7	1.4×
Blood test, magnesium CPT Code: `83735`	$98	$10	$7	1.4×
Blood test, sodium CPT Code: `84295`	$23	$7	$5	1.4×
Hepatitis C antibody test CPT Code: `86803`	$138	$21	$15	1.4×
Blood test, thyroid (TSH) CPT Code: `84443`	$234	$25	$18	1.4×
Culture, blood CPT Code: `87040`	$294	$15	$11	1.4×
Blood test, liver function panel CPT Code: `80076`	$283	$12	$9	1.3×
Blood test, average blood sugar (A1c) CPT Code: `83036`	—	$10	$10	1.0×
Extended office visit (prolonged) HCPCS Code: `G2212`	$69	$32	$33	1.0×
Flu vaccine (high dose) HCPCS Code: `90656`	$56	$23	$25	0.9×
Hepatitis B vaccine HCPCS Code: `90744`	$76	$33	$37	0.9×
DTaP vaccine (diphtheria, tetanus, pertussis) HCPCS Code: `90700`	$92	$33	$39	0.8×
Diagnostic procedure preparation HCPCS Code: `G0279`	$100	$24	$35	0.7×
Flu vaccine injection HCPCS Code: `G0008`	$67	$31	$48	0.6×
Pneumonia vaccine injection HCPCS Code: `G0009`	$65	$31	$49	0.6×
Colorectal cancer screening HCPCS Code: `G0010`	$82	$31	$49	0.6×
Blood test, clotting time (PT/INR) CPT Code: `85610`	—	$4	$5	0.8×
Blood test, hemoglobin CPT Code: `85018`	—	$2	$3	0.7×
Electrocardiogram (ECG/EKG) CPT Code: `93000`	$34	$14	$25	0.6×
Blood test, basic metabolic panel CPT Code: `80048`	—	—	$9	unverified
Culture, bacterial CPT Code: `87070`	—	—	$9	—

Showing top 25 high-impact procedures of 119 total

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 33.9%

Audit a Bill or Quote at Saint Joseph Regional Medical Center (Zero PHI Required)

CMS CCN: 150012

CPT 451

Select Procedure to Audit:

Fair BaseRate™ $30,775

Medicare Rate $23,504

Self-Pay Cash $58,091

Insurer Median $60,735

1. Amount on Your Bill or Quote ($) Pre-filled with Saint Joseph Regional Medical 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: $49,399 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $49,399

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (33.9% of gross = $49,399).

Step 2 · Cash vs. Insurance Arbitrage Save $87,673 Paying Cash

Self-Pay Cash Rate ($58,091) Beats Your Bill

Saint Joseph Regional Medical Center's published 45 CFR § 180 self-pay cash rate is $58,091 (vs. $60,735 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$114,989 Above Fair BaseRate

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

Your bill ($145,764) is $114,989 above the denoised Fair BaseRate ($30,775) and 6.2× 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)

EIN: 351568821

Filing Period: 194603

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 (33.9% 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 Composite63/100

Would Recommend67%

Rated 9 or 10 (HCAHPS)65%

Median ER Wait188 min

Left ER Before Seen2%

30-Day Mortality vs U.S.same

Unplanned Readmissionsame

Hip/Knee Complication Rate4.2%

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 (527 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 Quality & Price Benchmark

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Saint Joseph Regional Medical Center.

Price Index: 1.34× regional baseline

Quality: 58/100 CMS composite

Notable Payer Contract Outliers (SVD Matrix Anomalies)

Community Health Alliance

-68.3%

Kaiser Permanente

-60.3%

Benefit Administrative Systems,Llc

-55.5%

Health Choices

-54.9%

Median Household Income$64,885U.S. Census ACS

Local Uninsured Share7.3%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 68/100 · Caution CMS CCN 150012 EIN 351568821

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 150012) ↗ Verify IRS Form 990 (EIN 351568821) ↗ CMS HCRIS Cost Reports ↗

Published MRF FileCMS_45_CFR_180_FILING.json

Publication / Vintage2026-03-31

Validated Rate Rows30,830 (CMS v3.0.0)

File Integrity DigestVerified · CCN 150012

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