Thedacare Medical Center - Berlin Inc
225 Memorial Drive, Berlin, WI 54923 · 93 Priced Procedures · 71% Patient Recommendation
Typical commercial prices here are +152% above the fair benchmark (2.52×) even after accounting for local nurse/doctor wages and patient complexity.
4-Star CMS clinical quality rating paired with 2.52× fair market pricing.
Wide Procedure Spread · Upper-Quartile Skew Pricer
Thedacare Medical Center - Berlin Inc prices routine shoppable procedures at 4.1× Medicare (median 2.28× Fair BaseRate) while upper-quartile commercial rates jump +47% to 3.36× Fair BaseRate. Self-pay cash discounts and comparing specific CPT procedure codes before scheduling yield the strongest savings.
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 59% of shoppable procedures (99/100 Cash Honesty)
- CMS clinical safety score (73/100 safety score) with 71% patient recommendation
- IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (37.3% AGB cap)
Where You Can Get Burned (Markup Traps)
- Outpatient surgery & OR suites carry a 1.8× markup over Medicare rates
- Commercial insurance median sits at 2.28× Fair BaseRate (4.1× Medicare), so insured patients should always compare the self-pay cash price before paying.
- Upper-quartile procedures (Q75 3.36×) jump +47% above the median procedure ratio (Q50 2.28×)
- Unnegotiated chargemaster list prices average 6.5× Medicare (20¢ true HCRIS cost per $1 gross)
Pre-scheduled outpatient procedures where patients can comparison-shop.
Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.
Detects median-gaming when upper-quartile codes spike above the p50 median.
Procedure Prices at Thedacare Medical Center - Berlin Inc
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.
| Procedure & Billing Code | This Hospital | vs. Fair |
|---|---|---|
| Hip or knee replacement (inpatient stay) MS-DRG Code: 470 | $43,937 | unverified |
| Sepsis treatment (inpatient stay) MS-DRG Code: 871 | $16,313 | 0.9× |
| Digestive disorders treatment (inpatient stay) MS-DRG Code: 392 | $16,266 | 2.0× |
| Trauma team activation HCPCS Code: G0390 | $9,879 | unverified |
| Gallbladder removal (laparoscopic) CPT Code: 47562 | $8,627 | 1.4× |
| Total knee replacement CPT Code: 27447 | $8,085 | 0.6× |
| Knee arthroscopy with meniscus repair CPT Code: 29881 | $5,144 | 1.5× |
| Cataract surgery with lens implant CPT Code: 66984 | $3,963 | 1.6× |
| Sleep study (overnight, in lab) CPT Code: 95810 | $3,613 | unverified |
| Total hip replacement CPT Code: 27130 | $3,271 | 0.2× |
| Colonoscopy with biopsy CPT Code: 45380 | $2,801 | unverified |
| MRI, brain (with and without contrast) CPT Code: 70553 | $2,689 | unverified |
| MRI, lower back (no contrast) CPT Code: 72148 | $2,287 | unverified |
| MRI, brain (no contrast) CPT Code: 70551 | $2,203 | unverified |
| MRI, knee or other leg joint CPT Code: 73721 | $2,089 | unverified |
| CT scan, abdomen and pelvis (with contrast) CPT Code: 74177 | $2,072 | unverified |
| CT scan, abdomen and pelvis (no contrast) CPT Code: 74176 | $1,904 | unverified |
| Colonoscopy (diagnostic) CPT Code: 45378 | $1,871 | 1.9× |
| CT scan, head (with and without contrast) CPT Code: 70470 | $1,752 | unverified |
| Upper endoscopy with biopsy CPT Code: 43239 | $1,703 | 1.7× |
| Injection procedure for pain management HCPCS Code: G0260 | $1,618 | 1.9× |
| CT scan, lower back (lumbar spine) CPT Code: 72131 | $1,630 | unverified |
| CT scan, chest (no contrast) CPT Code: 71250 | $1,587 | unverified |
| CT scan, sinuses CPT Code: 70486 | $1,492 | unverified |
| CT scan, head (no contrast) CPT Code: 70450 | $1,456 | unverified |
Audit a Bill or Quote at Thedacare Medical Center - Berlin Inc (Zero PHI Required)
Statutory 501(r) AGB Cap Limits Bill to $29,241
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (37.3% of gross = $29,241).
Self-Pay Cash Rate ($43,937) Beats Your Bill
Thedacare Medical Center - Berlin Inc's published 45 CFR § 180 self-pay cash rate is $43,937 (vs. $43,937 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.
Negotiate Toward $19,432 Fair BaseRate ($14,044 Medicare)
Your bill ($78,458) is $59,026 above the denoised Fair BaseRate ($19,432) and 5.6× the $14,044 Medicare rate.
Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)
Hospital-Specific CMS HCRIS Benchmark (37.3% 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.
Clinical Quality, Patient Experience & Infection Benchmarks
Source: CMS Hospital Care Compare (181 completed HCAHPS patient surveys). Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.
How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings
2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Thedacare Medical Center - Berlin Inc.
Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings
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.