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CMS Price Transparency Data Hospital file updated: 2026-06-27

Behavioral health day program

Facility: Gundersen St Josephs Hospital and Clinics

Billing Code: H2012 (HCPCS)

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
$161Fair BaseRate (5.07× Market)
Position vs. 1.00× Fair Price+407% 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 $817 compared to the $161 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-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 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.

The BaseRate · fair price low confidence
A fair price for this
$161
modeled fair price · typically $36–$836
modeled estimate · not a bill or quote
What this hospital charges insurers
$817
Well above the fair price
about $656 over the fair price
Fair price $161 This hospital $817

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

Highest price of the 9 WI hospitals we have prices for — worth calling around.

Cheapest $77 Priciest $817

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

A fair price for a Behavioral health day program is about $161. Gundersen St Josephs Hospital and Clinics charges insurers about $817 — well above the fair price. Located in Hillsboro, WI.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $161. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

1 of 6 major insurers have a published price at this hospital

Blue Cross Blue Shield UnitedHealthcareAetnaCignaHumanaKaiser 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
Blue Cross Blue Shieldmajor $817 —
Amerigroup $143 —
Dean Health Plan $817 —
Quartz $817 —
+ 4 smaller / regional plans $817 - $897

Self-Pay How to get the cash price

Insurance Before you use insurance

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

Enter your details and press estimate to compare.

Facility Profile & Credentials

  • Address: 400 Water Ave, Hillsboro, WI 54634
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals

Other Procedures at Gundersen St Josephs Hospital and Clinics

Compare: Behavioral health day program at other WI hospitals

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 Gundersen St Josephs Hospital and Clinics (Zero PHI Required)

CMS CCN: 521304
HCPCS H2012
Fair BaseRate™ $161
Medicare Rate $93
Self-Pay Cash Request Quote
Insurer Median $817
Pre-filled with Gundersen St Josephs Hospital and Clinics’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: $712 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $712

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 = $712).

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

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask Gundersen St Josephs Hospital and Clinics'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 +$1,800 Above Fair BaseRate

Negotiate Toward $161 Fair BaseRate ($93 Medicare)

Your bill ($1,961) is $1,800 above the denoised Fair BaseRate ($161) and 21.1× the $93 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, HCPCS code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.
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 521304

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

MRF Portal Indexed (gundersen-st-josephs!390929538_st-josephs-health-services-inc_standardcharges.csv) Verify on CMS Medicare.gov (CCN 521304) ↗ CMS HCRIS Cost Reports ↗
Published MRF Filegundersen-st-josephs!390929538_st-josephs-health-services-inc_standardcharges.csv
Publication / Vintage2026-06-27 · 2.82 MB
Validated Rate Rows695,055 (CMS v3.0.0)
File Integrity Digesta56c4931c6921e891aa6…

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