How many shoppable procedure prices are published for SSM Health St Mary's Hospital - Madison?

SSM Health St Mary's Hospital - Madison in Madison, WI currently has 118 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do SSM Health St Mary's Hospital - Madison's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, SSM Health St Mary's Hospital - Madison's median negotiated commercial rate is 1.6× the regionally adjusted fair BaseRate benchmark.

What is SSM Health St Mary's Hospital - Madison's CMS Care Compare overall star rating?

CMS Care Compare assigns SSM Health St Mary's Hospital - Madison an overall hospital quality rating of 4 out of 5 stars based on public federal clinical and patient-experience measures.

Hospital Profile Acute Care Hospital Voluntary non-profit - Private 354 Beds · urban Updated: 2026-04-01

SSM Health St Mary's Hospital - Madison

700 South Park St, Madison, WI 53715 · 118 Priced Procedures · 74% Patient Recommendation

CMS Overall Rating 4 / 5 Stars

High Markup · Shop Alternatives

1.55×vs. Fair Market Price

Typical commercial prices here are +55% above the fair benchmark (1.55×) even after accounting for local nurse/doctor wages and patient complexity.

81/100 · Corroborated

81/100Self-Pay Cash Beats Insurance 24% of the Time

File Completeness66

Price Logic85

Peer Alignment72

Clean Billing84

Real Cash Discount100

High-Markup · Check Safety

4-Star CMS clinical quality rating paired with 1.55× fair market pricing.

Behavioral Pricing FingerprintUpper-Quartile Spread · +33% Tail Jump

Wide Procedure Spread · Upper-Quartile Skew Pricer

SSM Health St Mary's Hospital - Madison prices routine shoppable procedures at 2.7× Medicare (median 1.68× Fair BaseRate) while upper-quartile commercial rates jump +33% to 2.24× Fair BaseRate. Self-pay cash discounts and comparing specific CPT procedure codes before scheduling yield the strongest savings.

#56 of 99 in WI · 55th State Percentile#2,716 of 3,385 in U.S. · 80th National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Bottom-quartile procedures (Q25) price at 0.93× the peer BaseRate benchmark
Self-pay cash beats commercial insurance on 24% of shoppable procedures (99/100 Cash Honesty)
4-Star CMS clinical rating with 74% patient recommendation (75/100 safety score)
IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (17.6% AGB cap)

Watchout

Where You Can Get Burned (Markup Traps)

Outpatient surgery & OR suites carry a 1.8× markup over Medicare rates
Commercial insurance median sits at 1.68× Fair BaseRate (2.7× Medicare), so insured patients should always compare the self-pay cash price before paying.
Upper-quartile procedures (Q75 2.24×) jump +33% above the median procedure ratio (Q50 1.68×)
Consolidated metro market (HHI 2,886) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))

Front-Door ShoppableElective / Imaging

2.7× Medicare

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

Back-Door Captive & ER0.70× Divergence

1.9× Medicare

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

Quantile Tail Spread+33% Upper Tail

Q25 0.93× · Q50 1.68× · Q75 2.24×

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

2.7× MedicareFair

Outpatient Surgery & ORBack-Door Captive

1.8× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

4.0× MedicareElevated

Back-Door Captive ER VisitsBack-Door Captive

3.1× MedicareFair

Inpatient Lab & PathologyBack-Door Captive

3.0× MedicareFair

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

1.6× MedicareGood

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

24% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

4 CMS · 75/100Fair

Procedure Prices at SSM Health St Mary's Hospital - Madison

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 118 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`	—	$64,653	$30,775	unverified
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	—	$38,877	$19,087	unverified
Hip or knee replacement (inpatient stay) MS-DRG Code: `470`	—	$38,605	$19,432	2.0×
Heart stent placement (inpatient stay) MS-DRG Code: `322`	—	$35,285	$17,936	2.0×
Total knee replacement CPT Code: `27447`	—	$21,291	$13,523	1.6×
Total hip replacement CPT Code: `27130`	—	$20,346	$13,413	1.5×
Gallbladder removal (laparoscopic) CPT Code: `47562`	—	$20,161	$6,109	unverified
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	—	$15,603	$8,223	1.9×
Vaginal delivery (full package) CPT Code: `59400`	—	$9,825	$2,680	3.7×
C-section delivery (full package) CPT Code: `59510`	—	$9,825	$2,975	3.3×
Trauma team activation HCPCS Code: `G0390`	$7,966	$7,966	$1,453	5.5×
Knee arthroscopy with meniscus repair CPT Code: `29881`	—	$7,548	$3,372	2.2×
Bunion correction surgery CPT Code: `28296`	—	$7,548	$3,446	2.2×
Inguinal hernia repair CPT Code: `49505`	—	$7,548	$3,629	2.1×
Breast lump removal CPT Code: `19120`	—	$7,084	$3,875	1.8×
Cataract surgery with lens implant CPT Code: `66984`	—	$6,240	$2,540	2.5×
Colonoscopy with biopsy CPT Code: `45380`	—	$4,423	$1,256	3.5×
Colonoscopy (diagnostic) CPT Code: `45378`	—	$4,031	$981	4.1×
Upper endoscopy with biopsy CPT Code: `43239`	$2,857	$4,031	$987	4.1×
Injection procedure for pain management HCPCS Code: `G0260`	$2,901	$3,696	$855	4.3×
MRI, brain (with and without contrast) CPT Code: `70553`	$3,292	$2,127	$511	4.2×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$3,053	$1,783	$448	unverified
Blood transfusion CPT Code: `36430`	$1,420	$1,420	$498	unverified
MRI, knee or other leg joint CPT Code: `73721`	$2,179	$1,363	$369	3.7×
MRI, brain (no contrast) CPT Code: `70551`	$1,800	$1,265	$343	3.7×
MRI, lower back (no contrast) CPT Code: `72148`	$2,194	$1,199	$338	3.5×
CT scan, neck (cervical spine) CPT Code: `72125`	$1,594	$1,059	$169	unverified
CT scan, head (with and without contrast) CPT Code: `70470`	$1,422	$1,033	$258	4.0×
CT scan, chest (no contrast) CPT Code: `71250`	$1,546	$1,045	$167	unverified
CT scan, lower back (lumbar spine) CPT Code: `72131`	$2,265	$1,048	$168	unverified
Ultrasound, abdomen (complete) CPT Code: `76700`	$1,016	$1,016	$134	unverified
Ultrasound, pelvis CPT Code: `76856`	$1,041	$1,041	$130	unverified
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$2,775	$908	$303	3.0×
CT scan, head (with contrast) CPT Code: `70460`	$1,139	$850	$242	3.5×
Ultrasound, thyroid and neck CPT Code: `76536`	$860	$860	$132	unverified
CT scan, sinuses CPT Code: `70486`	$1,048	$786	$166	4.7×
CT scan, pelvis CPT Code: `72192`	$1,586	$737	$163	4.5×
Sleep study (overnight, in lab) CPT Code: `95810`	$920	$730	$1,021	0.7×
CT scan, head (no contrast) CPT Code: `70450`	$1,044	$591	$160	3.7×
Ultrasound, abdomen (limited) CPT Code: `76705`	$884	$504	$126	4.0×
Echocardiogram (heart ultrasound) CPT Code: `93306`	$1,857	$464	$583	0.8×
Rabies immune globulin HCPCS Code: `90375`	—	$418	$322	1.3×
Psychological testing by technician CPT Code: `96138`	—	$380	$395	1.0×
Diagnostic mammogram (both breasts) CPT Code: `77066`	$366	$366	$148	unverified
X-ray, hip CPT Code: `73502`	$337	$243	$93	2.6×
X-ray, lower back CPT Code: `72110`	$524	$266	$112	2.4×
Hepatitis B immune globulin HCPCS Code: `90371`	—	$208	$151	1.4×
X-ray, ankle CPT Code: `73610`	$351	$182	$93	2.0×
X-ray, neck (cervical spine) CPT Code: `72040`	$427	$176	$93	1.9×
X-ray, hand CPT Code: `73130`	$282	$176	$93	1.9×
X-ray, foot CPT Code: `73630`	$357	$167	$92	1.8×
X-ray, pelvis CPT Code: `72170`	$315	$185	$110	1.7×
Breathing treatment (nebulizer) CPT Code: `94640`	$279	$186	$201	0.9×
Neurobehavioral status check CPT Code: `96116`	—	$184	$231	0.8×
Ultrasound, leg veins (duplex) CPT Code: `93970`	$1,533	$203	$272	0.7×
Diagnostic procedure preparation HCPCS Code: `G0279`	—	$206	$35	unverified
X-ray, chest (two views) CPT Code: `71046`	$266	$158	$93	1.7×
X-ray, shoulder CPT Code: `73030`	$386	$156	$92	1.7×
Psychotherapy session (45 minutes) CPT Code: `90834`	—	$151	$166	0.9×
Family therapy session CPT Code: `90847`	—	$151	$173	0.9×
Psychotherapy session (60 minutes) CPT Code: `90837`	—	$151	$181	0.8×
Psychiatric evaluation (first visit) CPT Code: `90791`	$469	$151	$185	0.8×
Office visit, established patient (30-39 min) CPT Code: `99214`	$124	$124	$123	1.0×
Office visit, established patient (20-29 min) CPT Code: `99213`	$90	$90	$87	1.0×
Psychological testing evaluation CPT Code: `96136`	—	$113	$128	0.9×
X-ray, chest (single view) CPT Code: `71045`	$244	$85	$92	0.9×
Typhoid vaccine HCPCS Code: `90675`	—	$491	$347	1.4×
Pneumococcal vaccine HCPCS Code: `90732`	—	$194	$140	1.4×
Drug screening test HCPCS Code: `G0480`	$162	$162	$116	1.4×
Prostate cancer screening (blood test) HCPCS Code: `G0103`	$167	$34	$20	1.7×
Blood test, vitamin D CPT Code: `82306`	$38	$52	$31	1.7×
Hepatitis B vaccine HCPCS Code: `90744`	—	$46	$37	1.2×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	—	$57	$56	1.0×
Flu vaccine injection HCPCS Code: `G0008`	$134	$40	$48	0.8×
Pneumonia vaccine injection HCPCS Code: `G0009`	$134	$40	$49	0.8×
Colorectal cancer screening HCPCS Code: `G0010`	$134	$40	$49	0.8×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$180	$50	$64	0.8×
Speech therapy (language evaluation) CPT Code: `92507`	$268	$65	$86	0.8×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$63	$6	$3	2.0×
Blood test, clotting time (PTT) CPT Code: `85730`	$31	$11	$6	1.8×
Blood test, calcium CPT Code: `82310`	$18	$9	$5	1.8×
Blood test, creatinine (kidney) CPT Code: `82565`	$6	$9	$5	1.8×
Blood test, glucose (blood sugar) CPT Code: `82947`	$31	$7	$4	1.8×
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$31	$7	$4	1.8×
Blood test, complete blood count (CBC) CPT Code: `85025`	$155	$14	$8	1.8×
Blood test, lipase CPT Code: `83690`	$56	$12	$7	1.7×
Blood test, magnesium CPT Code: `83735`	$27	$12	$7	1.7×
Blood test, average blood sugar (A1c) CPT Code: `83036`	$69	$17	$10	1.7×
Blood test, basic metabolic panel CPT Code: `80048`	$174	$15	$9	1.7×
Hepatitis C antibody test CPT Code: `86803`	$141	$25	$15	1.7×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$37	$23	$14	1.6×
Flu vaccine (high dose) HCPCS Code: `90656`	—	$41	$25	1.6×
Culture, bacterial CPT Code: `87070`	$109	$15	$9	1.7×
Blood test, comprehensive metabolic panel CPT Code: `80053`	$212	$18	$11	1.6×
Culture, blood CPT Code: `87040`	$174	$18	$11	1.6×
Blood test, thyroid (TSH) CPT Code: `84443`	$106	$29	$18	1.6×
Orthotic fitting and training CPT Code: `97760`	$105	$39	$51	0.8×
Blood test, amylase CPT Code: `82150`	$74	$11	$7	1.6×
Blood test, liver function panel CPT Code: `80076`	$151	$14	$9	1.6×
Blood test, ferritin (iron stores) CPT Code: `82728`	$12	$12	$14	0.9×
Prosthetic fitting and training CPT Code: `97761`	$124	$34	$45	0.8×
Blood test, potassium CPT Code: `84132`	$37	$8	$5	1.6×
Blood test, sodium CPT Code: `84295`	$35	$8	$5	1.6×
Blood test, clotting time (PT/INR) CPT Code: `85610`	$22	$8	$5	1.6×
Blood test, hemoglobin CPT Code: `85018`	$39	$4	$3	1.3×
Electrical stimulation therapy HCPCS Code: `G0283`	—	$11	$14	0.8×
Physical therapy (functional capacity test) CPT Code: `97750`	$111	$29	$38	0.8×
Physical therapy (gait training) CPT Code: `97116`	$109	$25	$33	0.8×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$113	$30	$40	0.8×
Speech therapy (group session) CPT Code: `92508`	—	$20	$27	0.7×
Blood test, PSA (prostate screen) CPT Code: `84153`	$14	$14	$19	0.7×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$107	$28	$38	0.7×
Occupational therapy (self-care training) CPT Code: `97535`	$111	$28	$38	0.7×
Blood antibody screen CPT Code: `86850`	$108	$33	$46	0.7×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$120	$25	$35	0.7×
Physical therapy (manual therapy) CPT Code: `97140`	$111	$24	$34	0.7×
Blood test, vitamin B12 CPT Code: `82607`	$9	$9	$16	0.6×
Hospital observation (per hour) HCPCS Code: `G0378`	$2	$2	$86	0.0×

Showing top 25 high-impact procedures of 118 total

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 17.6%

Audit a Bill or Quote at SSM Health St Mary's Hospital - Madison (Zero PHI Required)

CMS CCN: 520083

CPT 451

Select Procedure to Audit:

Fair BaseRate™ $30,775

Medicare Rate $23,504

Self-Pay Cash Request Quote

Insurer Median $64,653

1. Amount on Your Bill or Quote ($) Pre-filled with SSM Health St Mary's Hospital - Madison’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: $27,340 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $27,340

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (17.6% of gross = $27,340).

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

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask SSM Health St Mary's Hospital - Madison'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 +$124,392 Above Fair BaseRate

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

Your bill ($155,167) is $124,392 above the denoised Fair BaseRate ($30,775) and 6.6× 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)

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 (17.6% 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

CMS Overall4/5 Stars (4/5)

Safety Composite75/100

Would Recommend74%

Rated 9 or 10 (HCAHPS)73%

Median ER Wait192 min

Left ER Before Seen3%

30-Day Mortality vs U.S.same

Unplanned Readmissionsame

Hip/Knee Complication Rate3%

Healthcare-Associated Infections (CDC NHSN / CMS HAI)

1.00 SIR = National Predicted Baseline (Lower Is Safer)

Central-Line Bloodstream Infectionbetter

C. diff Hospital-Onset Infectionbetter

Source: CMS Hospital Care Compare (1,112 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

Regional Quality & Price Benchmark

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for SSM Health St Mary's Hospital - Madison.

Price Index: 1.03× regional baseline

Quality: 76/100 CMS composite

Median Household Income$88,108U.S. Census ACS

Local Uninsured Share3.6%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 81/100 · Corroborated CMS CCN 520083

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 520083) ↗ CMS HCRIS Cost Reports ↗

Published MRF FileCMS_45_CFR_180_FILING.json

Publication / Vintage2026-04-01

Validated Rate Rows528 (CMS v3.0.0)

File Integrity DigestVerified · CCN 520083

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