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Hospital Profile Critical Access Hospital Voluntary non-profit - Private 15 Beds · rural Updated: 2026-02-28

Madison St Joseph Health Center

100 West Cross Street, Madisonville, TX 77864 · 93 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.High Markup · Shop Alternatives
1.91×vs. Fair Market Price
Position vs. 1.00× Fair Price+91% 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 +91% above the fair benchmark (1.91×) 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).72/100 · Corroborated
72/100Self-Pay Cash Beats Insurance 87% of the Time
File Completeness66Provenance (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 Logic56Coherence (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 Alignment58Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing88Regularity (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.High-Markup · Check Safety
CMS Star RatingNot RatedOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety Score85/100Composite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER Wait104 minMedian 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 FingerprintUpper-Quartile Spread · +124% Tail Jump

Wide Procedure Spread · Upper-Quartile Skew Pricer

Madison St Joseph Health Center prices routine shoppable procedures at 3.1× Medicare (median 1.40× Fair BaseRate) while upper-quartile commercial rates jump +124% to 3.13× Fair BaseRate. Self-pay cash discounts and comparing specific CPT procedure codes before scheduling yield the strongest savings.

#264 of 307 in TX · 85th State Percentile#3,035 of 3,385 in U.S. · 89th National Percentile
Advantage

Where They're Good (Patient & Payer Edge)

  • Bottom-quartile procedures (Q25) price at 0.89× the peer BaseRate benchmark
  • Self-pay cash beats commercial insurance on 87% of shoppable procedures (99/100 Cash Honesty)
  • CMS clinical safety score (85/100 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 (34.6% AGB cap)
Watchout

Where You Can Get Burned (Markup Traps)

  • Outpatient surgery & OR suites carry a 3.9× markup over Medicare rates
  • Commercial insurance median sits at 1.40× Fair BaseRate (3.1× Medicare), so insured patients should always compare the self-pay cash price before paying.
  • Upper-quartile procedures (Q75 3.13×) jump +124% above the median procedure ratio (Q50 1.40×)
  • Unnegotiated chargemaster list prices average 16.1× Medicare (14¢ true HCRIS cost per $1 gross)
Front-Door ShoppableElective / Imaging
3.1× Medicare

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

Back-Door Captive & ER0.52× Divergence
1.6× Medicare

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

Quantile Tail Spread+124% Upper Tail
Q25 0.89× · Q50 1.40× · Q75 3.13×

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
3.1× MedicareFair
Outpatient Surgery & ORBack-Door Captive
3.9× MedicareElevated
Diagnostic Imaging (CT/MRI)Front-Door Shoppable
5.8× MedicareWatchout
Back-Door Captive ER VisitsBack-Door Captive
2.1× MedicareGood
Inpatient Lab & PathologyBack-Door Captive
6.2× MedicareWatchout
Specialty & Infusion Drugs (J-Codes)Back-Door Captive
1.8× MedicareGood
Self-Pay Cash Honesty & 501(r)Integrity & Outcomes
87% Cash Edge · 99/100Good
CMS Clinical Safety & Star ValueIntegrity & Outcomes
3 CMS · 85/100Good

Procedure Prices at Madison St Joseph Health Center

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 93 published procedures.

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Audit a Bill & 501(r) Cap ↓
Procedure & Billing Code This Hospital vs. Fair
Sepsis treatment (inpatient stay)
MS-DRG Code: 871
 $23,518 1.2×
Hip or knee replacement (inpatient stay)
MS-DRG Code: 470
 $22,600 1.2×
Spinal fusion, single level (inpatient stay)
MS-DRG Code: 451
 $21,573 0.7×
Total hip replacement
CPT Code: 27130
 $16,720 1.2×
Total knee replacement
CPT Code: 27447
 $16,720 1.2×
Heart stent placement (inpatient stay)
MS-DRG Code: 322
 $16,368 0.9×
Digestive disorders treatment (inpatient stay)
MS-DRG Code: 392
 $9,353 1.1×
Gallbladder removal (laparoscopic)
CPT Code: 47562
 $5,027 0.8×
Sleep study (overnight, in lab)
CPT Code: 95810
 $3,803 unverified
C-section delivery (full package)
CPT Code: 59510
 $3,513 1.2×
Trauma team activation
HCPCS Code: G0390
 $3,160 2.2×
Vaginal delivery (full package)
CPT Code: 59400
 $3,169 1.2×
Inguinal hernia repair
CPT Code: 49505
 $3,065 0.8×
Knee arthroscopy with meniscus repair
CPT Code: 29881
 $2,897 0.9×
Bunion correction surgery
CPT Code: 28296
 $2,897 0.8×
Cataract surgery with lens implant
CPT Code: 66984
 $2,262 0.9×
Echocardiogram (heart ultrasound)
CPT Code: 93306
 $1,827 unverified
CT scan, abdomen and pelvis (with contrast)
CPT Code: 74177
 $1,676 3.7×
CT scan, abdomen and pelvis (no contrast)
CPT Code: 74176
 $1,676 unverified
MRI, brain (with and without contrast)
CPT Code: 70553
 $1,547 3.0×
MRI, lower back (no contrast)
CPT Code: 72148
 $1,450 4.3×
MRI, brain (no contrast)
CPT Code: 70551
 $1,450 4.2×
CT scan, head (with and without contrast)
CPT Code: 70470
 $1,206 4.7×
CT scan, head (with contrast)
CPT Code: 70460
 $1,073 unverified
Upper endoscopy with biopsy
CPT Code: 43239
 $892 0.9×
Showing top 25 high-impact procedures of 93 total
Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 34.6%

Audit a Bill or Quote at Madison St Joseph Health Center (Zero PHI Required)

CMS CCN: 451316
CPT 871
Fair BaseRate™ $19,087
Medicare Rate $14,117
Self-Pay Cash Request Quote
Insurer Median $23,518
Pre-filled with Madison St Joseph Health 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: $19,557 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $19,557

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (34.6% of gross = $19,557).

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

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask Madison St Joseph Health Center'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 +$37,356 Above Fair BaseRate

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

Your bill ($56,443) is $37,356 above the denoised Fair BaseRate ($19,087) and 4.0× 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) 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 (34.6% 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 ↑
CMS Care Compare Public Quality Record

Clinical Quality, Patient Experience & Infection Benchmarks

Safety Composite85/100
Median ER Wait104 min
Left ER Before Seen0%

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

Higher-Quality, Above-Median Price Tier

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Madison St Joseph Health Center.

Price Index: 1.09× regional baseline
Quality: 57/100 CMS composite
Median Household Income$67,128U.S. Census ACS
Local Uninsured Share14.9%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 72/100 · Corroborated CMS CCN 451316

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 451316) ↗ CMS HCRIS Cost Reports ↗
Published MRF FileCMS_45_CFR_180_FILING.json
Publication / Vintage2026-02-28
Validated Rate Rows2,851 (CMS v3.0.0)
File Integrity DigestVerified · CCN 451316

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