How many shoppable procedure prices are published for Gundersen St Josephs Hospital and Clinics?

Gundersen St Josephs Hospital and Clinics in Hillsboro, WI currently has 133 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do Gundersen St Josephs Hospital and Clinics's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, Gundersen St Josephs Hospital and Clinics's median negotiated commercial rate is 2.4× the regionally adjusted fair BaseRate benchmark.

Hospital Profile Critical Access Hospital Voluntary non-profit - Private 25 Beds · rural Updated: 2026-06-27

Gundersen St Josephs Hospital and Clinics

400 Water Ave, Hillsboro, WI 54634 · 133 Priced Procedures · 80% Patient Recommendation

CMS Overall Rating No CMS Rating

High Markup · Shop Alternatives

2.37×vs. Fair Market Price

Typical commercial prices here are +137% above the fair benchmark (2.37×) even after accounting for local nurse/doctor wages and patient complexity.

87/100 · Verified

87/100Self-Pay Cash Beats Insurance 75% of the Time

File Completeness100

Price Logic84

Peer Alignment74

Clean Billing76

Real Cash Discount100

High-Markup · Check Safety

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

Behavioral Pricing FingerprintUpper-Quartile Spread · +59% Tail Jump

Wide Procedure Spread · Upper-Quartile Skew Pricer

Gundersen St Josephs Hospital and Clinics prices routine shoppable procedures at 3.0× Medicare (median 2.04× Fair BaseRate) while upper-quartile commercial rates jump +59% to 3.25× Fair BaseRate. Self-pay cash discounts and comparing specific CPT procedure codes before scheduling yield the strongest savings.

#89 of 99 in WI · 88th State Percentile#3,220 of 3,385 in U.S. · 95th National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Bottom-quartile procedures (Q25) price at 1.56× the peer BaseRate benchmark
Self-pay cash beats commercial insurance on 75% of shoppable procedures (99/100 Cash Honesty)
CMS clinical safety score (72/100 safety score) with 80% patient recommendation
IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (57.9% 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 2.04× Fair BaseRate (3.0× Medicare), so insured patients should always compare the self-pay cash price before paying.
Upper-quartile procedures (Q75 3.25×) jump +59% above the median procedure ratio (Q50 2.04×)
Consolidated metro market (HHI 5,439) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))

Front-Door ShoppableElective / Imaging

3.0× Medicare

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

Back-Door Captive & ER0.57× Divergence

1.7× Medicare

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

Quantile Tail Spread+59% Upper Tail

Q25 1.56× · Q50 2.04× · Q75 3.25×

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

3.0× MedicareFair

Outpatient Surgery & ORBack-Door Captive

1.1× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

1.6× MedicareGood

Back-Door Captive ER VisitsBack-Door Captive

0.8× MedicareGood

Inpatient Lab & PathologyBack-Door Captive

0.9× MedicareGood

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

0.8× MedicareGood

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

75% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

3 CMS · 72/100Fair

Procedure Prices at Gundersen St Josephs Hospital and Clinics

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 133 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`	—	$55,154	$30,775	1.8×
Total hip replacement CPT Code: `27130`	—	$23,795	$13,413	unverified
Total knee replacement CPT Code: `27447`	—	$23,795	$13,523	unverified
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	—	$19,632	$19,087	1.0×
Hip or knee replacement (inpatient stay) MS-DRG Code: `470`	—	$19,494	$19,432	1.0×
Heart stent placement (inpatient stay) MS-DRG Code: `322`	—	$17,818	$17,936	1.0×
Bunion correction surgery CPT Code: `28296`	—	$15,192	$3,446	unverified
Inguinal hernia repair CPT Code: `49505`	—	$9,990	$3,629	unverified
Gallbladder removal (laparoscopic) CPT Code: `47562`	—	$9,584	$6,109	1.6×
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	—	$7,879	$8,223	1.0×
C-section delivery (full package) CPT Code: `59510`	—	$6,712	$2,975	2.3×
Vaginal delivery (full package) CPT Code: `59400`	—	$6,070	$2,680	2.3×
Knee arthroscopy with meniscus repair CPT Code: `29881`	—	$5,643	$3,372	1.7×
Cataract surgery with lens implant CPT Code: `66984`	—	$4,660	$2,540	1.8×
Breast lump removal CPT Code: `19120`	—	$3,433	$3,875	0.9×
Upper endoscopy with biopsy CPT Code: `43239`	$1,620	$2,592	$987	2.6×
Colonoscopy (diagnostic) CPT Code: `45378`	$1,620	$2,544	$981	2.6×
Colonoscopy with biopsy CPT Code: `45380`	$1,620	$2,544	$1,256	2.0×
MRI, brain (with and without contrast) CPT Code: `70553`	$2,531	$2,222	$511	unverified
Sleep study (overnight, in lab) CPT Code: `95810`	$3,699	$1,908	$1,021	1.9×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$2,091	$1,759	$448	unverified
Psychological testing by technician CPT Code: `96138`	—	$1,575	$395	unverified
Residential mental health treatment HCPCS Code: `H2036`	—	$1,531	$406	3.8×
Behavioral health counseling (group) HCPCS Code: `H0009`	—	$1,348	$269	5.0×
Behavioral health day treatment HCPCS Code: `H0010`	—	$1,348	$343	3.9×
MRI, brain (no contrast) CPT Code: `70551`	$1,997	$1,329	$343	3.9×
Behavioral health residential care HCPCS Code: `H0011`	—	$1,348	$364	3.7×
MRI, lower back (no contrast) CPT Code: `72148`	$1,656	$1,329	$338	unverified
MRI, knee or other leg joint CPT Code: `73721`	$1,741	$1,329	$369	unverified
Behavioral health counseling (per session) HCPCS Code: `H0008`	—	$1,348	$257	unverified
CT scan, head (with and without contrast) CPT Code: `70470`	$1,105	$1,264	$258	unverified
Echocardiogram (heart ultrasound) CPT Code: `93306`	$1,220	$1,195	$583	2.0×
Blood transfusion CPT Code: `36430`	$801	$1,158	$498	2.3×
Injection procedure for pain management HCPCS Code: `G0260`	—	$1,158	$855	1.4×
CT scan, head (with contrast) CPT Code: `70460`	$1,384	$1,122	$242	unverified
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$2,028	$1,090	$303	3.6×
Trauma team activation HCPCS Code: `G0390`	$1,087	$1,087	$1,453	0.7×
CT scan, head (no contrast) CPT Code: `70450`	$885	$907	$160	unverified
Behavioral health day program HCPCS Code: `H2012`	—	$817	$100	8.2×
Mental health services (assessment) HCPCS Code: `H0031`	—	$628	$140	4.5×
Behavioral health assessment HCPCS Code: `H0001`	—	$628	$157	4.0×
Group therapy session CPT Code: `90853`	—	$610	$100	unverified
CT scan, pelvis CPT Code: `72192`	$1,242	$570	$163	3.5×
CT scan, sinuses CPT Code: `70486`	$1,097	$570	$166	3.4×
CT scan, chest (no contrast) CPT Code: `71250`	$1,127	$570	$167	3.4×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$1,251	$570	$168	3.4×
CT scan, neck (cervical spine) CPT Code: `72125`	$1,127	$570	$169	3.4×
Rabies immune globulin HCPCS Code: `90375`	$4,690	$548	$322	1.7×
Care planning with family CPT Code: `90887`	—	$411	$107	3.8×
Ultrasound, abdomen (limited) CPT Code: `76705`	$373	$419	$126	3.3×
Ultrasound, pelvis CPT Code: `76856`	$756	$422	$130	3.2×
Ultrasound, abdomen (complete) CPT Code: `76700`	$794	$422	$134	3.1×
Family therapy session CPT Code: `90847`	—	$411	$173	2.4×
Ultrasound, leg veins (duplex) CPT Code: `93970`	$1,155	$421	$272	1.5×
Ultrasound, thyroid and neck CPT Code: `76536`	$572	$419	$132	unverified
Psychotherapy session (45 minutes) CPT Code: `90834`	—	$346	$166	2.1×
Psychotherapy session (60 minutes) CPT Code: `90837`	—	$346	$181	1.9×
Residential substance abuse treatment HCPCS Code: `H2035`	—	$312	$88	3.5×
Behavioral health living support HCPCS Code: `H2019`	—	$312	$34	unverified
Hepatitis B immune globulin HCPCS Code: `90371`	—	$269	$151	1.8×
Mental health services (therapy) HCPCS Code: `H0032`	—	$208	$65	3.2×
Review of medical records for care CPT Code: `90889`	—	$208	$114	1.8×
Speech therapy (language evaluation) CPT Code: `92507`	$223	$223	$86	unverified
Screening mammogram (both breasts) CPT Code: `77067`	$212	$189	$123	1.5×
Diagnostic mammogram (both breasts) CPT Code: `77066`	$264	$203	$148	1.4×
X-ray, chest (single view) CPT Code: `71045`	$192	$149	$92	1.6×
X-ray, shoulder CPT Code: `73030`	$225	$149	$92	1.6×
X-ray, foot CPT Code: `73630`	$238	$149	$92	1.6×
X-ray, chest (two views) CPT Code: `71046`	$211	$149	$93	1.6×
X-ray, neck (cervical spine) CPT Code: `72040`	$225	$149	$93	1.6×
X-ray, hand CPT Code: `73130`	$181	$149	$93	1.6×
X-ray, hip CPT Code: `73502`	$225	$149	$93	1.6×
X-ray, ankle CPT Code: `73610`	$181	$149	$93	1.6×
X-ray, pelvis CPT Code: `72170`	$177	$149	$110	1.4×
X-ray, lower back CPT Code: `72110`	$577	$149	$112	1.3×
Breathing treatment (nebulizer) CPT Code: `94640`	$174	$163	$201	0.8×
Orthotic fitting and training CPT Code: `97760`	$105	$155	$51	unverified
Diagnostic procedure preparation HCPCS Code: `G0279`	—	$117	$35	3.3×
Speech therapy (group session) CPT Code: `92508`	—	$88	$27	3.3×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$85	$92	$35	2.6×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$105	$92	$38	2.4×
Physical therapy (functional capacity test) CPT Code: `97750`	$105	$92	$38	2.4×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$114	$92	$40	2.3×
Prosthetic fitting and training CPT Code: `97761`	$180	$92	$45	2.0×
Physical therapy (manual therapy) CPT Code: `97140`	$105	$97	$34	unverified
Occupational therapy (self-care training) CPT Code: `97535`	$137	$110	$38	unverified
Office visit, established patient (30-39 min) CPT Code: `99214`	$83	$83	$123	unverified
Typhoid vaccine HCPCS Code: `90675`	$420	$333	$347	1.0×
Drug screening test HCPCS Code: `G0480`	—	$139	$116	1.2×
Pneumonia vaccine injection HCPCS Code: `G0009`	—	$108	$49	2.2×
Colorectal cancer screening HCPCS Code: `G0010`	—	$108	$49	2.2×
Flu vaccine injection HCPCS Code: `G0008`	—	$108	$48	unverified
Electrocardiogram (ECG/EKG) CPT Code: `93000`	$115	$67	$25	2.7×
Physical therapy (gait training) CPT Code: `97116`	$105	$79	$33	2.4×
Blood test, vitamin D CPT Code: `82306`	$164	$56	$31	1.8×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$78	$67	$64	1.0×
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	$44	$75	$111	0.7×
Office visit, established patient (20-29 min) CPT Code: `99213`	$65	$65	$87	unverified
Hospital observation (per hour) HCPCS Code: `G0378`	$60	$60	$86	unverified
Blood test, glucose (blood sugar) CPT Code: `82947`	$23	$23	$4	5.8×
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$22	$22	$4	5.5×
Blood test, calcium CPT Code: `82310`	$28	$11	$5	2.2×
Blood test, creatinine (kidney) CPT Code: `82565`	$28	$11	$5	2.2×
Blood test, potassium CPT Code: `84132`	$26	$11	$5	2.2×
Blood test, sodium CPT Code: `84295`	$27	$11	$5	2.2×
Blood test, basic metabolic panel CPT Code: `80048`	$47	$18	$9	2.0×
Blood test, liver function panel CPT Code: `80076`	$45	$18	$9	2.0×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$17	$6	$3	2.0×
Blood test, ferritin (iron stores) CPT Code: `82728`	$75	$24	$14	1.7×
Blood test, vitamin B12 CPT Code: `82607`	$83	$27	$16	1.7×
Blood test, comprehensive metabolic panel CPT Code: `80053`	$58	$18	$11	1.6×
Blood test, amylase CPT Code: `82150`	$36	$11	$7	1.6×
Blood test, lipase CPT Code: `83690`	$38	$11	$7	1.6×
Blood test, magnesium CPT Code: `83735`	$26	$11	$7	1.6×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$74	$18	$14	1.3×
Blood test, PSA (prostate screen) CPT Code: `84153`	$102	$24	$19	1.3×
Blood test, average blood sugar (A1c) CPT Code: `83036`	$54	$11	$10	1.1×
Prostate cancer screening (blood test) HCPCS Code: `G0103`	$107	$22	$20	1.1×
Hepatitis B vaccine HCPCS Code: `90744`	$45	$40	$37	1.1×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$85	$46	$56	0.8×
Varicella (chickenpox) vaccine HCPCS Code: `90716`	$65	$65	$203	0.3×
Blood test, hemoglobin CPT Code: `85018`	$13	$13	$3	4.3×
Culture, bacterial CPT Code: `87070`	$34	$17	$9	1.9×
Blood test, clotting time (PT/INR) CPT Code: `85610`	$24	$9	$5	1.8×
Culture, blood CPT Code: `87040`	$57	$17	$11	1.5×
Blood test, thyroid (TSH) CPT Code: `84443`	$93	$27	$18	1.5×
Blood test, complete blood count (CBC) CPT Code: `85025`	$43	$12	$8	1.5×
Blood test, clotting time (PTT) CPT Code: `85730`	$24	$9	$6	1.5×
Hepatitis C antibody test CPT Code: `86803`	$79	$22	$15	1.5×
Flu vaccine (high dose) HCPCS Code: `90656`	$39	$27	$25	1.1×
DTaP vaccine (diphtheria, tetanus, pertussis) HCPCS Code: `90700`	$30	$30	$39	0.8×
Blood antibody screen CPT Code: `86850`	$54	$9	$46	0.2×
Pneumococcal vaccine HCPCS Code: `90732`	$18	$18	$140	0.1×

Showing top 25 high-impact procedures of 133 total

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 57.9%

Audit a Bill or Quote at Gundersen St Josephs Hospital and Clinics (Zero PHI Required)

CMS CCN: 521304

CPT 451

Select Procedure to Audit:

Fair BaseRate™ $30,775

Medicare Rate $23,504

Self-Pay Cash Request Quote

Insurer Median $55,154

1. Amount on Your Bill or Quote ($) Pre-filled with Gundersen St Josephs Hospital and Clinics’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: $76,616 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $76,616

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (57.9% of gross = $76,616).

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 +$101,595 Above Fair BaseRate

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

Your bill ($132,370) is $101,595 above the denoised Fair BaseRate ($30,775) and 5.6× 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: 390929538

Filing Period: 201004

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 (57.9% 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

Safety Composite72/100

Would Recommend80%

Rated 9 or 10 (HCAHPS)80%

Median ER Wait116 min

Left ER Before Seen0%

30-Day Mortality vs U.S.same

Unplanned Readmissionsame

Source: CMS Hospital Care Compare (56 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

Above-Benchmark Price Tier

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Gundersen St Josephs Hospital and Clinics.

Price Index: 1.79× regional baseline

Quality: 59/100 CMS composite

Median Household Income$69,556U.S. Census ACS

Local Uninsured Share14.7%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 87/100 · Verified CMS CCN 521304 EIN 390929538

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

Download Official Hospital MRF ↗ Verify on CMS Medicare.gov (CCN 521304) ↗ Verify IRS Form 990 (EIN 390929538) ↗ 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 Rows4,382 (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