How many shoppable procedure prices are published for Saint Joseph Hospital?

Saint Joseph Hospital in Lexington, KY currently has 112 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do Saint Joseph Hospital's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, Saint Joseph Hospital's median negotiated commercial rate is 2.0× the regionally adjusted fair BaseRate benchmark.

What is Saint Joseph Hospital's CMS Care Compare overall star rating?

CMS Care Compare assigns Saint Joseph Hospital an overall hospital quality rating of 3 out of 5 stars based on public federal clinical and patient-experience measures.

Hospital Profile Acute Care Hospital Voluntary non-profit - Church 267 Beds · urban Updated: 2026-02-28

Saint Joseph Hospital

One Saint Joseph Drive, Lexington, KY 40504 · 112 Priced Procedures · 64% Patient Recommendation

CMS Overall Rating 3 / 5 Stars

High Markup · Shop Alternatives

2.04×vs. Fair Market Price

Typical commercial prices here are +104% above the fair benchmark (2.04×) even after accounting for local nurse/doctor wages and patient complexity.

76/100 · Corroborated

76/100Self-Pay Cash Beats Insurance 83% of the Time

File Completeness56

Price Logic76

Peer Alignment74

Clean Billing78

Real Cash Discount100

High-Markup · Check Safety

3-Star CMS clinical quality rating paired with 2.04× fair market pricing.

Behavioral Pricing FingerprintUpper-Quartile Spread · +57% Tail Jump

Wide Procedure Spread · Upper-Quartile Skew Pricer

Saint Joseph Hospital prices routine shoppable procedures at 2.9× Medicare (median 1.86× Fair BaseRate) while upper-quartile commercial rates jump +57% to 2.92× Fair BaseRate. Self-pay cash discounts and comparing specific CPT procedure codes before scheduling yield the strongest savings.

#62 of 68 in KY · 89th State Percentile#3,097 of 3,385 in U.S. · 91st National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Bottom-quartile procedures (Q25) price at 0.99× the peer BaseRate benchmark
Self-pay cash beats commercial insurance on 83% of shoppable procedures (99/100 Cash Honesty)
CMS clinical safety score (66/100 safety score) with 64% patient recommendation
IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (30.7% AGB cap)

Watchout

Where You Can Get Burned (Markup Traps)

Outpatient surgery & OR suites carry a 1.1× markup over Medicare rates
Commercial insurance median sits at 1.86× Fair BaseRate (2.9× Medicare), so insured patients should always compare the self-pay cash price before paying.
Upper-quartile procedures (Q75 2.92×) jump +57% above the median procedure ratio (Q50 1.86×)
Consolidated metro market (HHI 2,973) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))

Front-Door ShoppableElective / Imaging

2.9× Medicare

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

Back-Door Captive & ER0.41× Divergence

1.2× Medicare

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

Quantile Tail Spread+57% Upper Tail

Q25 0.99× · Q50 1.86× · Q75 2.92×

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

2.9× MedicareFair

Outpatient Surgery & ORBack-Door Captive

1.1× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

3.5× MedicareElevated

Back-Door Captive ER VisitsBack-Door Captive

4.2× MedicareElevated

Inpatient Lab & PathologyBack-Door Captive

4.5× MedicareWatchout

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

2.0× MedicareGood

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

83% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

3 CMS · 66/100Fair

Procedure Prices at Saint Joseph Hospital

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 112 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`	—	$22,383	$30,775	0.7×
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	—	$14,358	$19,087	0.8×
Hip or knee replacement (inpatient stay) MS-DRG Code: `470`	—	$13,981	$19,432	0.7×
Heart stent placement (inpatient stay) MS-DRG Code: `322`	—	$13,266	$17,936	0.7×
Total hip replacement CPT Code: `27130`	—	$12,831	$13,413	1.0×
Total knee replacement CPT Code: `27447`	—	$12,831	$13,523	0.9×
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	—	$5,919	$8,223	0.7×
Gallbladder removal (laparoscopic) CPT Code: `47562`	—	$5,732	$6,109	0.9×
Breast lump removal CPT Code: `19120`	—	$3,779	$3,875	1.0×
Rabies immune globulin HCPCS Code: `90375`	$3,643	$3,643	$322	11.3×
Inguinal hernia repair CPT Code: `49505`	—	$3,544	$3,629	1.0×
Knee arthroscopy with meniscus repair CPT Code: `29881`	—	$3,299	$3,372	1.0×
Bunion correction surgery CPT Code: `28296`	—	$3,248	$3,446	0.9×
Vaginal delivery (full package) CPT Code: `59400`	—	$3,078	$2,680	1.1×
C-section delivery (full package) CPT Code: `59510`	—	$3,078	$2,975	1.0×
Cataract surgery with lens implant CPT Code: `66984`	—	$2,342	$2,540	0.9×
Upper endoscopy with biopsy CPT Code: `43239`	$1,462	$1,890	$987	1.9×
Sleep study (overnight, in lab) CPT Code: `95810`	$3,078	$1,835	$1,021	1.8×
Colonoscopy with biopsy CPT Code: `45380`	$1,681	$1,713	$1,256	1.4×
Echocardiogram (heart ultrasound) CPT Code: `93306`	$2,001	$1,193	$583	2.0×
MRI, brain (no contrast) CPT Code: `70551`	$1,290	$1,129	$343	3.3×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$1,884	$1,080	$448	2.4×
MRI, lower back (no contrast) CPT Code: `72148`	$926	$1,088	$338	unverified
CT scan, neck (cervical spine) CPT Code: `72125`	$1,603	$919	$169	5.4×
Blood transfusion CPT Code: `36430`	$718	$928	$498	1.9×
Colonoscopy (diagnostic) CPT Code: `45378`	—	$936	$981	1.0×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$1,677	$961	$303	unverified
Ultrasound, leg veins (duplex) CPT Code: `93970`	$963	$875	$272	3.2×
MRI, brain (with and without contrast) CPT Code: `70553`	$1,524	$874	$511	1.7×
Injection procedure for pain management HCPCS Code: `G0260`	$757	$895	$855	1.0×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$1,553	$890	$168	unverified
CT scan, head (with and without contrast) CPT Code: `70470`	$1,108	$699	$258	2.7×
MRI, knee or other leg joint CPT Code: `73721`	$1,019	$590	$369	1.6×
CT scan, sinuses CPT Code: `70486`	$961	$551	$166	3.3×
X-ray, lower back CPT Code: `72110`	$445	$567	$112	unverified
Ultrasound, abdomen (complete) CPT Code: `76700`	$891	$521	$134	3.9×
CT scan, chest (no contrast) CPT Code: `71250`	$934	$535	$167	3.2×
Ultrasound, abdomen (limited) CPT Code: `76705`	$865	$506	$126	4.0×
CT scan, head (no contrast) CPT Code: `70450`	$842	$483	$160	3.0×
Ultrasound, pelvis CPT Code: `76856`	$773	$452	$130	3.5×
CT scan, pelvis CPT Code: `72192`	$832	$477	$163	2.9×
CT scan, head (with contrast) CPT Code: `70460`	$791	$454	$242	1.9×
X-ray, shoulder CPT Code: `73030`	$373	$467	$92	unverified
X-ray, ankle CPT Code: `73610`	$328	$418	$93	unverified
X-ray, chest (two views) CPT Code: `71046`	$308	$392	$93	unverified
X-ray, hand CPT Code: `73130`	$315	$401	$93	unverified
X-ray, foot CPT Code: `73630`	$320	$407	$92	unverified
Ultrasound, thyroid and neck CPT Code: `76536`	$570	$333	$132	2.5×
Diagnostic mammogram (both breasts) CPT Code: `77066`	$258	$345	$148	2.3×
Office visit, established patient (30-39 min) CPT Code: `99214`	$266	$350	$123	unverified
X-ray, hip CPT Code: `73502`	$238	$303	$93	3.3×
X-ray, pelvis CPT Code: `72170`	$235	$299	$110	2.7×
Neurobehavioral status check CPT Code: `96116`	$394	$320	$231	1.4×
Hepatitis B immune globulin HCPCS Code: `90371`	$289	$289	$151	1.9×
Speech therapy (language evaluation) CPT Code: `92507`	$201	$251	$86	2.9×
X-ray, chest (single view) CPT Code: `71045`	$217	$265	$92	2.9×
New patient office visit (30-44 min) CPT Code: `99203`	$189	$249	$110	2.3×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$209	$187	$64	2.9×
Office visit, established patient (20-29 min) CPT Code: `99213`	$160	$210	$87	2.4×
X-ray, neck (cervical spine) CPT Code: `72040`	$349	$204	$93	2.2×
Screening mammogram (both breasts) CPT Code: `77067`	$163	$215	$123	1.7×
Psychiatric evaluation (first visit) CPT Code: `90791`	$353	$211	$185	1.1×
Psychological testing evaluation CPT Code: `96136`	$281	$167	$128	1.3×
Electrical stimulation therapy HCPCS Code: `G0283`	$144	$144	$14	unverified
Physical therapy (gait training) CPT Code: `97116`	$92	$118	$33	3.6×
Orthotic fitting and training CPT Code: `97760`	$112	$139	$51	2.7×
Physical therapy (manual therapy) CPT Code: `97140`	$122	$106	$34	3.1×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$104	$106	$35	3.0×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$90	$108	$38	2.8×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$79	$112	$40	2.8×
Physical therapy (functional capacity test) CPT Code: `97750`	$78	$101	$38	2.7×
Occupational therapy (self-care training) CPT Code: `97535`	$81	$89	$38	2.3×
Breathing treatment (nebulizer) CPT Code: `94640`	$67	$89	$201	0.4×
Typhoid vaccine HCPCS Code: `90675`	$576	$576	$347	1.7×
Blood test, comprehensive metabolic panel CPT Code: `80053`	$208	$208	$11	18.9×
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	$173	$222	$111	unverified
Drug screening test HCPCS Code: `G0480`	$131	$161	$116	1.4×
Blood test, liver function panel CPT Code: `80076`	$121	$121	$9	13.4×
Blood test, PSA (prostate screen) CPT Code: `84153`	$124	$124	$19	6.5×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$95	$114	$56	2.0×
Blood test, vitamin B12 CPT Code: `82607`	$82	$82	$16	5.1×
Blood test, thyroid (TSH) CPT Code: `84443`	$82	$82	$18	4.6×
Blood test, average blood sugar (A1c) CPT Code: `83036`	$106	$106	$10	unverified
Blood test, clotting time (PT/INR) CPT Code: `85610`	$58	$58	$5	11.6×
Blood test, magnesium CPT Code: `83735`	$60	$60	$7	8.6×
Blood antibody screen CPT Code: `86850`	$97	$80	$46	1.7×
Diagnostic procedure preparation HCPCS Code: `G0279`	$38	$51	$35	1.5×
Prosthetic fitting and training CPT Code: `97761`	$50	$62	$45	1.4×
Pneumococcal vaccine HCPCS Code: `90732`	$125	$72	$140	0.5×
Varicella (chickenpox) vaccine HCPCS Code: `90716`	$64	$82	$203	0.4×
Blood test, clotting time (PTT) CPT Code: `85730`	$72	$72	$6	unverified
Culture, bacterial CPT Code: `87070`	$79	$79	$9	unverified
Blood test, creatinine (kidney) CPT Code: `82565`	$25	$25	$5	5.0×
Blood test, vitamin D CPT Code: `82306`	$38	$50	$31	1.6×
Blood test, sodium CPT Code: `84295`	$23	$23	$5	4.6×
Blood test, basic metabolic panel CPT Code: `80048`	$109	$23	$9	2.6×
Flu vaccine injection HCPCS Code: `G0008`	$40	$47	$48	1.0×
Blood test, glucose (blood sugar) CPT Code: `82947`	$7	$8	$4	2.0×
Blood test, amylase CPT Code: `82150`	$10	$13	$7	1.9×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$118	$14	$14	1.0×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$56	$3	$3	1.0×
Blood test, calcium CPT Code: `82310`	$43	$5	$5	1.0×
Blood test, ferritin (iron stores) CPT Code: `82728`	$94	$14	$14	1.0×
Hepatitis B vaccine HCPCS Code: `90744`	$55	$34	$37	0.9×
Blood test, lipase CPT Code: `83690`	$74	$7	$7	1.0×
Blood test, potassium CPT Code: `84132`	$24	$5	$5	1.0×
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$20	$4	$4	1.0×
Blood test, complete blood count (CBC) CPT Code: `85025`	$83	$8	$8	1.0×
Hepatitis C antibody test CPT Code: `86803`	$75	$15	$15	1.0×
Culture, blood CPT Code: `87040`	$81	$11	$11	1.0×
Prostate cancer screening (blood test) HCPCS Code: `G0103`	$82	$20	$20	1.0×
Blood test, hemoglobin CPT Code: `85018`	$32	$2	$3	0.7×

Showing top 25 high-impact procedures of 112 total

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 30.7%

Audit a Bill or Quote at Saint Joseph Hospital (Zero PHI Required)

CMS CCN: 180010

CPT 451

Select Procedure to Audit:

Fair BaseRate™ $30,775

Medicare Rate $23,504

Self-Pay Cash Request Quote

Insurer Median $22,383

1. Amount on Your Bill or Quote ($) Pre-filled with Saint Joseph Hospital’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: $16,476 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $16,476

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (30.7% of gross = $16,476).

Step 2 · Cash vs. Insurance Arbitrage Request Prompt-Pay Quote

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask Saint Joseph Hospital's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.

Step 3 · Fair BaseRate Target +$22,944 Above Fair BaseRate

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

Your bill ($53,719) is $22,944 above the denoised Fair BaseRate ($30,775) and 2.3× 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)

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 (30.7% 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 Composite66/100

Would Recommend64%

Rated 9 or 10 (HCAHPS)64%

Median ER Wait135 min

Left ER Before Seen1%

30-Day Mortality vs U.S.better

Unplanned Readmissionsame

Hip/Knee Complication Rate4.3%

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

CMS Price Transparency Administrative Enforcement Log

Factual public administrative actions published by the Centers for Medicare & Medicaid Services regarding 45 CFR § 180 compliance at Saint Joseph Hospital. Prior administrative notices do not necessarily reflect current compliance status.

2025-06-11·administrative_or_closure
Met Requirements
Recorded
2025-06-04·administrative_or_closure
Met Requirements
Recorded

Source: CMS Hospital Care Compare (721 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

Higher-Quality, Above-Median Price Tier

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

Price Index: 2.01× regional baseline

Quality: 68/100 CMS composite

Notable Payer Contract Outliers (SVD Matrix Anomalies)

Blue Cross Blue Shield

-45.4%

Median Household Income$67,631U.S. Census ACS

Local Uninsured Share6.8%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 76/100 · Corroborated CMS CCN 180010

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 180010) ↗ CMS HCRIS Cost Reports ↗

Published MRF FileCMS_45_CFR_180_FILING.json

Publication / Vintage2026-02-28

Validated Rate Rows2,859 (CMS v3.0.0)

File Integrity DigestVerified · CCN 180010

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