How many shoppable procedure prices are published for Carlinville Area Hospital?

Carlinville Area Hospital in Carlinville, IL currently has 107 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

What is Carlinville Area Hospital's CMS Care Compare overall star rating?

CMS Care Compare assigns Carlinville Area Hospital an overall hospital quality rating of 2 out of 5 stars based on public federal clinical and patient-experience measures.

Hospital Profile Critical Access Hospital Voluntary non-profit - Private 25 Beds · rural Updated: 3/21/2026

Carlinville Area Hospital

20733 N Broad Street, Carlinville, IL 62626 · 107 Priced Procedures · 87% Patient Recommendation

CMS Overall Rating 2 / 5 Stars

Near Fair BaseRate Benchmark

1.00×vs. Fair Market Price

Typical commercial prices here match the fair market benchmark (1.00×) after accounting for local nurse/doctor wages and patient complexity.

80/100 · Corroborated

80/100Self-Pay Cash Beats Insurance 56% of the Time

File Completeness85

Price Logic71

Peer Alignment58

Clean Billing90

Real Cash Discount100

High-Markup Tier

2-Star CMS clinical quality rating paired with 1.00× fair market pricing.

Behavioral Pricing FingerprintConsistent Department Multiples

Aligned Regional Benchmark Peer

Carlinville Area Hospital prices shoppable and inpatient services (6.7× to 5.0× Medicare, divergence 0.75×) in alignment with regional hospital peers (1.00× Fair BaseRate). Reviewing plan-specific negotiated rates and cash discounts helps lock in the lowest out-of-pocket tier.

Regional Benchmark in ILU.S. National Reference Pool

Advantage

Where They're Good (Patient & Payer Edge)

Bottom-quartile procedures (Q25) price at 0.78× the peer BaseRate benchmark
Self-pay cash beats commercial insurance on 56% of shoppable procedures (99/100 Cash Honesty)
2-Star CMS clinical rating with 87% patient recommendation (74/100 safety score)
IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (57.2% AGB cap)

Watchout

Where You Can Get Burned (Markup Traps)

Outpatient surgery & OR suites carry a 2.2× markup over Medicare rates
Commercial insurance median sits at 1.00× Fair BaseRate (6.7× Medicare), so insured patients should always compare the self-pay cash price before paying.
Upper-quartile procedures (Q75 1.28×) jump +28% above the median procedure ratio (Q50 1.00×)
Unnegotiated chargemaster list prices average 10.1× Medicare (23¢ true HCRIS cost per $1 gross)

Front-Door ShoppableElective / Imaging

6.7× Medicare

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

Back-Door Captive & ER0.75× Divergence

5.0× Medicare

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

Quantile Tail Spread+28% Upper Tail

Q25 0.78× · Q50 1.00× · Q75 1.28×

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

6.7× MedicareWatchout

Outpatient Surgery & ORBack-Door Captive

2.2× MedicareFair

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

2.8× MedicareFair

Back-Door Captive ER VisitsBack-Door Captive

2.1× MedicareGood

Inpatient Lab & PathologyBack-Door Captive

2.4× MedicareFair

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

2.0× MedicareGood

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

56% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

2 CMS · 74/100Fair

Procedure Prices at Carlinville Area Hospital

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 107 published procedures.

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Audit a Bill & 501(r) Cap ↓

Procedure & Billing Code	Self-Pay Cash	This Hospital	Fair BaseRate	vs. Fair
MRI, brain (with and without contrast) CPT Code: `70553`	$4,351	$4,351	$511	8.5×
Total knee replacement CPT Code: `27447`	$3,684	$3,684	$13,523	0.3×
Sleep study (overnight, in lab) CPT Code: `95810`	$3,649	$3,649	$1,021	3.6×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$3,473	$3,473	$303	11.5×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$3,395	$3,395	$448	7.6×
Gallbladder removal (laparoscopic) CPT Code: `47562`	$3,066	$3,066	$6,109	0.5×
CT scan, head (with and without contrast) CPT Code: `70470`	$2,963	$2,963	$258	11.5×
MRI, lower back (no contrast) CPT Code: `72148`	$2,881	$2,881	$338	8.5×
CT scan, head (with contrast) CPT Code: `70460`	$2,692	$2,692	$242	11.1×
MRI, brain (no contrast) CPT Code: `70551`	$2,622	$2,622	$343	7.6×
Echocardiogram (heart ultrasound) CPT Code: `93306`	$2,606	$2,606	$583	4.5×
CT scan, neck (cervical spine) CPT Code: `72125`	$2,293	$2,293	$169	13.6×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$2,172	$2,172	$168	12.9×
MRI, knee or other leg joint CPT Code: `73721`	$1,949	$1,949	$369	5.3×
CT scan, head (no contrast) CPT Code: `70450`	$1,872	$1,872	$160	11.7×
CT scan, pelvis CPT Code: `72192`	$1,865	$1,865	$163	11.4×
CT scan, sinuses CPT Code: `70486`	$1,867	$1,867	$166	11.2×
CT scan, chest (no contrast) CPT Code: `71250`	$1,739	$1,739	$167	10.4×
Colonoscopy (diagnostic) CPT Code: `45378`	$1,488	$1,488	$981	1.5×
Inguinal hernia repair CPT Code: `49505`	$1,510	$1,510	$3,629	0.4×
Colonoscopy with biopsy CPT Code: `45380`	$1,443	$1,443	$1,256	1.1×
Blood transfusion CPT Code: `36430`	$1,204	$1,204	$498	2.4×
Knee arthroscopy with meniscus repair CPT Code: `29881`	$1,148	$1,148	$3,372	0.3×
Ultrasound, abdomen (complete) CPT Code: `76700`	$1,062	$1,062	$134	7.9×
Breast lump removal CPT Code: `19120`	$982	$982	$3,875	0.3×
Ultrasound, pelvis CPT Code: `76856`	$954	$954	$130	7.3×
Ultrasound, leg veins (duplex) CPT Code: `93970`	$895	$895	$272	3.3×
Ultrasound, abdomen (limited) CPT Code: `76705`	$769	$769	$126	6.1×
Upper endoscopy with biopsy CPT Code: `43239`	$710	$710	$987	0.7×
Ultrasound, thyroid and neck CPT Code: `76536`	$603	$603	$132	4.6×
Diagnostic mammogram (both breasts) CPT Code: `77066`	$437	$437	$148	3.0×
Speech therapy (language evaluation) CPT Code: `92507`	$349	$349	$86	4.1×
X-ray, foot CPT Code: `73630`	$312	$312	$92	3.4×
Group therapy session CPT Code: `90853`	$306	$306	$100	3.1×
X-ray, lower back CPT Code: `72110`	$328	$328	$112	2.9×
X-ray, chest (single view) CPT Code: `71045`	$281	$281	$92	3.1×
X-ray, ankle CPT Code: `73610`	$278	$278	$93	3.0×
X-ray, neck (cervical spine) CPT Code: `72040`	$277	$277	$93	3.0×
X-ray, hip CPT Code: `73502`	$268	$268	$93	2.9×
X-ray, pelvis CPT Code: `72170`	$285	$285	$110	2.6×
Screening mammogram (both breasts) CPT Code: `77067`	$306	$306	$123	2.5×
Psychotherapy session (60 minutes) CPT Code: `90837`	$323	$323	$181	1.8×
Psychiatric evaluation (first visit) CPT Code: `90791`	$322	$322	$185	1.7×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$253	$253	$64	4.0×
X-ray, hand CPT Code: `73130`	$253	$253	$93	2.7×
Family therapy session CPT Code: `90847`	$278	$278	$173	1.6×
X-ray, chest (two views) CPT Code: `71046`	$247	$247	$93	2.7×
New patient office visit (30-44 min) CPT Code: `99203`	$215	$215	$110	2.0×
Office visit, established patient (30-39 min) CPT Code: `99214`	$210	$210	$123	1.7×
Psychotherapy session (45 minutes) CPT Code: `90834`	$209	$209	$166	1.3×
Physical therapy (manual therapy) CPT Code: `97140`	$120	$120	$34	3.5×
Occupational therapy (self-care training) CPT Code: `97535`	$94	$94	$38	2.5×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$92	$92	$40	2.3×
Orthotic fitting and training CPT Code: `97760`	$112	$112	$51	2.2×
Office visit, established patient (20-29 min) CPT Code: `99213`	$133	$133	$87	1.5×
Diagnostic procedure preparation HCPCS Code: `G0279`	$92	$92	$35	2.6×
X-ray, shoulder CPT Code: `73030`	$109	$109	$92	1.2×
Psychological testing evaluation CPT Code: `96136`	$91	$91	$128	0.7×
Typhoid vaccine HCPCS Code: `90675`	$848	$848	$347	2.4×
Drug screening test HCPCS Code: `G0480`	$529	$529	$116	4.6×
Blood test, liver function panel CPT Code: `80076`	$183	$183	$9	20.3×
Blood test, comprehensive metabolic panel CPT Code: `80053`	$174	$174	$11	15.8×
Pneumococcal vaccine HCPCS Code: `90732`	$197	$197	$140	1.4×
Blood test, ferritin (iron stores) CPT Code: `82728`	$145	$145	$14	10.4×
Blood test, vitamin D CPT Code: `82306`	$166	$166	$31	5.4×
Blood test, lipase CPT Code: `83690`	$103	$103	$7	14.7×
Blood test, amylase CPT Code: `82150`	$96	$96	$7	13.7×
Blood test, basic metabolic panel CPT Code: `80048`	$118	$118	$9	13.1×
Culture, bacterial CPT Code: `87070`	$116	$116	$9	12.9×
Culture, blood CPT Code: `87040`	$126	$126	$11	11.5×
Hepatitis C antibody test CPT Code: `86803`	$134	$134	$15	8.9×
Blood test, PSA (prostate screen) CPT Code: `84153`	$122	$122	$19	6.4×
Prostate cancer screening (blood test) HCPCS Code: `G0103`	$123	$123	$20	6.2×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$119	$119	$56	2.1×
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	$125	$125	$111	1.1×
Varicella (chickenpox) vaccine HCPCS Code: `90716`	$141	$141	$203	0.7×
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$89	$89	$4	22.3×
Blood test, sodium CPT Code: `84295`	$70	$70	$5	14.0×
Blood test, magnesium CPT Code: `83735`	$89	$89	$7	12.7×
Blood test, complete blood count (CBC) CPT Code: `85025`	$92	$92	$8	11.5×
Blood test, average blood sugar (A1c) CPT Code: `83036`	$84	$84	$10	8.4×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$55	$55	$3	18.3×
Blood test, creatinine (kidney) CPT Code: `82565`	$65	$65	$5	13.0×
Blood test, vitamin B12 CPT Code: `82607`	$90	$90	$16	5.6×
Blood test, glucose (blood sugar) CPT Code: `82947`	$58	$58	$4	14.5×
Blood test, clotting time (PT/INR) CPT Code: `85610`	$66	$66	$5	13.2×
Blood test, clotting time (PTT) CPT Code: `85730`	$69	$69	$6	11.5×
Blood test, calcium CPT Code: `82310`	$51	$51	$5	10.2×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$76	$76	$14	5.4×
Blood test, thyroid (TSH) CPT Code: `84443`	$82	$82	$18	4.6×
Physical therapy (gait training) CPT Code: `97116`	$78	$78	$33	2.4×
Blood antibody screen CPT Code: `86850`	$86	$86	$46	1.9×
Blood test, potassium CPT Code: `84132`	$55	$55	$5	11.0×
Physical therapy (functional capacity test) CPT Code: `97750`	$78	$78	$38	2.1×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$72	$72	$38	1.9×
Extended office visit (prolonged) HCPCS Code: `G2212`	$57	$57	$33	1.7×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$60	$60	$35	1.7×
Prosthetic fitting and training CPT Code: `97761`	$64	$64	$45	1.4×
Breathing treatment (nebulizer) CPT Code: `94640`	$60	$60	$201	0.3×
Blood test, hemoglobin CPT Code: `85018`	$30	$30	$3	10.0×
Flu vaccine (high dose) HCPCS Code: `90656`	$51	$51	$25	2.0×
Hepatitis B vaccine HCPCS Code: `90744`	$60	$60	$37	1.6×
DTaP vaccine (diphtheria, tetanus, pertussis) HCPCS Code: `90700`	$52	$52	$39	1.3×
Hospital observation (per hour) HCPCS Code: `G0378`	$71	$71	$86	0.8×
Pneumonia vaccine injection HCPCS Code: `G0009`	$34	$34	$49	0.7×
Flu vaccine injection HCPCS Code: `G0008`	$30	$30	$48	0.6×
Colorectal cancer screening HCPCS Code: `G0010`	$27	$27	$49	0.6×

Showing top 25 high-impact procedures of 107 total

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 57.2%

Audit a Bill or Quote at Carlinville Area Hospital (Zero PHI Required)

CMS CCN: 141347

CPT 70553

Select Procedure to Audit:

Fair BaseRate™ $511

Medicare Rate $356

Self-Pay Cash $4,351

Insurer Median $4,351

1. Amount on Your Bill or Quote ($) Pre-filled with Carlinville Area Hospital’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: $3,558 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $3,558

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (57.2% of gross = $3,558).

Step 2 · Cash vs. Insurance Arbitrage Save $1,865 Paying Cash

Self-Pay Cash Rate ($4,351) Beats Your Bill

Carlinville Area Hospital's published 45 CFR § 180 self-pay cash rate is $4,351 (vs. $4,351 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$5,705 Above Fair BaseRate

Negotiate Toward $511 Fair BaseRate ($356 Medicare)

Your bill ($6,216) is $5,705 above the denoised Fair BaseRate ($511) and 17.5× the $356 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: 370645239

Filing Period: 195608

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 (57.2% 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 Overall2/5 Stars (2/5)

Safety Composite74/100

Would Recommend87%

Rated 9 or 10 (HCAHPS)83%

Median ER Wait124 min

30-Day Mortality vs U.S.same

Unplanned Readmissionsame

CMS Price Transparency Administrative Enforcement Log

Factual public administrative actions published by the Centers for Medicare & Medicaid Services regarding 45 CFR § 180 compliance at Carlinville Area Hospital. Prior administrative notices do not necessarily reflect current compliance status.

2025-03-03·administrative_or_closure
Closure Notice
Recorded
2025-01-08·cap_corrective_action
CAP Request
Recorded
2024-10-10·cap_corrective_action
CAP Request
Recorded

Source: CMS Hospital Care Compare (57 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 Carlinville Area Hospital.

Price Index: 1.71× regional baseline

Quality: 48/100 CMS composite

Notable Payer Contract Outliers (SVD Matrix Anomalies)

Health Net

-46.2%

Meridian

+74.8%

Humana

+148.9%

Median Household Income$68,518U.S. Census ACS

Local Uninsured Share4.3%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 80/100 · Corroborated CMS CCN 141347 EIN 370645239

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

Download Official Hospital MRF ↗ Verify on CMS Medicare.gov (CCN 141347) ↗ Verify IRS Form 990 (EIN 370645239) ↗ CMS HCRIS Cost Reports ↗

Published MRF File370645239_Carlinville-Area-Hospital-Association_standardcharges.csv

Publication / Vintage3/21/2026 · 217.16 MB

Validated Rate Rows12,666 (CMS v3.0.0)

File Integrity Digeste796532bd2866e0a9c63…

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