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Hospital Profile Psychiatric Hospital Voluntary non-profit - Private 30 Beds · rural Updated: 2026-03-10

Shodair Children's Hospital

2755 Colonial Dr, Helena, MT 59601 · 27 Priced Procedures

CMS Overall Rating No CMS Rating
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.Above Fair Market · Negotiate
1.13×vs. Fair Market Price
Position vs. 1.00× Fair Price+13% 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.

Typical commercial prices here are +13% above the fair benchmark (1.13×) even after accounting for local nurse/doctor wages and patient complexity.

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).68/100 · Caution
68/100Self-Pay Cash Beats Insurance 17% of the Time
File Completeness60Provenance (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 Logic73Coherence (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 Alignment61Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing49Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount100Cash 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.Regional Benchmark Tier
CMS Star RatingNot RatedOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety ScoreNot ScoredComposite 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.

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

Behavioral Pricing FingerprintHigh-HHI Market Leverage

Consolidated System Premium Pricer

Operating in a concentrated regional market (CBSA HHI 8,107), Shodair Children's Hospital commands a 1.13× BaseRate commercial premium across insurers. Self-pay cash quotes, in-state peer hospitals, and freestanding outpatient facilities offer critical leverage against consolidated system pricing.

#13 of 26 in MT · 46th State Percentile#1,791 of 3,385 in U.S. · 52nd National Percentile
Advantage

Where They're Good (Patient & Payer Edge)

  • Bottom-quartile procedures (Q25) price at 0.82× the peer BaseRate benchmark
  • Self-pay cash beats commercial insurance on 17% of shoppable procedures (99/100 Cash Honesty)
  • CMS clinical safety score (54/100 safety score) with 72% patient recommendation
  • IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (46.6% AGB cap)
Watchout

Where You Can Get Burned (Markup Traps)

  • Outpatient surgery & OR suites carry a 1.6× markup over Medicare rates
  • Commercial insurance median sits at 1.12× Fair BaseRate (1.3× Medicare), so insured patients should always compare the self-pay cash price before paying.
  • Upper-quartile procedures (Q75 1.33×) jump +19% above the median procedure ratio (Q50 1.12×)
  • Consolidated metro market (HHI 8,107) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))
Front-Door ShoppableElective / Imaging
1.3× Medicare

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

Back-Door Captive & ER0.85× Divergence
1.1× Medicare

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

Quantile Tail Spread+19% Upper Tail
Q25 0.82× · Q50 1.12× · Q75 1.33×

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
1.3× MedicareGood
Outpatient Surgery & ORBack-Door Captive
1.6× MedicareGood
Diagnostic Imaging (CT/MRI)Front-Door Shoppable
1.4× MedicareGood
Back-Door Captive ER VisitsBack-Door Captive
1.9× MedicareGood
Inpatient Lab & PathologyBack-Door Captive
1.1× MedicareGood
Specialty & Infusion Drugs (J-Codes)Back-Door Captive
0.8× MedicareGood
Self-Pay Cash Honesty & 501(r)Integrity & Outcomes
17% Cash Edge · 99/100Good
CMS Clinical Safety & Star ValueIntegrity & Outcomes
3 CMS · 54/100Elevated

Procedure Prices at Shodair Children's Hospital

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 27 published procedures.

Sort:
Audit a Bill & 501(r) Cap ↓
Procedure & Billing Code This Hospital vs. Fair
Psychotherapy session (60 minutes)
CPT Code: 90837
 $202 1.1×
Psychiatric evaluation (first visit)
CPT Code: 90791
 $203 1.1×
Family therapy session
CPT Code: 90847
 $170 1.0×
Speech therapy (language evaluation)
CPT Code: 92507
 $190 unverified
Care planning with family
CPT Code: 90887
 $124 1.2×
New patient office visit (30-44 min)
CPT Code: 99203
 $123 1.1×
Office visit, established patient (30-39 min)
CPT Code: 99214
 $128 1.0×
Psychotherapy session (45 minutes)
CPT Code: 90834
 $135 0.8×
Neurobehavioral status check
CPT Code: 96116
 $138 0.6×
Occupational therapy (therapeutic activities)
CPT Code: 97530
 $88 2.2×
Physical therapy (neuromuscular re-education)
CPT Code: 97112
 $82 2.2×
Office visit, established patient (20-29 min)
CPT Code: 99213
 $83 1.0×
Occupational therapy (self-care training)
CPT Code: 97535
 $81 unverified
Physical therapy (therapeutic exercise)
CPT Code: 97110
 $73 2.1×
Blood test, thyroid (TSH)
CPT Code: 84443
 $34 1.9×
Speech therapy (group session)
CPT Code: 92508
 $44 1.6×
Group therapy session
CPT Code: 90853
 $52 unverified
Blood test, cholesterol (lipid panel)
CPT Code: 80061
 $19 1.4×
Blood test, average blood sugar (A1c)
CPT Code: 83036
 $13 1.3×
Blood test, vitamin D
CPT Code: 82306
 $17 0.5×
Psychological testing evaluation
CPT Code: 96136
 $40 0.3×
Psychological testing by technician
CPT Code: 96138
 $61 0.2×
Behavioral health living support
HCPCS Code: H2019
 $9 0.3×
Behavioral health day program
HCPCS Code: H2012
 $22 0.2×
Blood test, comprehensive metabolic panel
CPT Code: 80053
 $12 unverified
Showing top 25 high-impact procedures of 27 total
Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 46.6%

Audit a Bill or Quote at Shodair Children's Hospital (Zero PHI Required)

CMS CCN: 274004
CPT 90837
Fair BaseRate™ $181
Medicare Rate $181
Self-Pay Cash $238
Insurer Median $202
Pre-filled with Shodair Children's Hospital’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: $148 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $148

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (46.6% of gross = $148).

Step 2 · Cash vs. Insurance Arbitrage Save $80 Paying Cash

Self-Pay Cash Rate ($238) Beats Your Bill

Shodair Children's Hospital's published 45 CFR § 180 self-pay cash rate is $238 (vs. $202 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$137 Above Fair BaseRate

Negotiate Toward $181 Fair BaseRate ($181 Medicare)

Your bill ($318) is $137 above the denoised Fair BaseRate ($181) and 1.8× the $181 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 (46.6% 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 ↑
Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

Regional Quality & Price Benchmark Pareto Frontier (Price + Quality)

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Shodair Children's Hospital.

Price Index: 0.86× regional baseline
Quality: 54/100 CMS composite
Median Household Income$74,543U.S. Census ACS
Local Uninsured Share6.2%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 274004

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

Download Official Hospital MRF ↗ Verify on CMS Medicare.gov (CCN 274004) ↗ CMS HCRIS Cost Reports ↗
Published MRF FileReports.aspx
Publication / Vintage2026-03-10 · 0.34 MB
Validated Rate Rows62 (CMS v3.0.0)
File Integrity DigestVerified · CCN 274004

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