Fayette County Hospital
650 W Taylor St, Vandalia, IL 62471 · 105 Priced Procedures · 78% Patient Recommendation
Typical commercial prices here match the fair market benchmark (1.01×) after accounting for local nurse/doctor wages and patient complexity.
Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.
Loss-Leader / Captive Ancillary Cross-Subsidizer
Fayette County Hospital prices routine shoppable procedures near 0.8× Medicare (p50 0.86×) while skewing captive emergency, lab, and upper-quartile codes to 1.5× Medicare (p75 1.57×, +83% upper-tail jump). Patients scheduling elective outpatient care can capture competitive rates, but emergency and ancillary bills require strict line-item auditing.
Where They're Good (Patient & Payer Edge)
- Bottom-quartile procedures (Q25) price at 0.37× the peer BaseRate benchmark
- Self-pay cash beats commercial insurance on 19% of shoppable procedures (25/100 Cash Honesty)
- CMS clinical safety score (69/100 safety score) with 78% patient recommendation
- IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (34.5% AGB cap)
Where You Can Get Burned (Markup Traps)
- Even at low-cost facilities (1.01× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
- Captive ER (0.6×) & laboratory (1.6×) services average 1.88× higher multiples than routine shoppable care (0.8×)
- Upper-quartile procedures (Q75 1.57×) jump +83% above the median procedure ratio (Q50 0.86×)
- Unnegotiated chargemaster list prices average 10.9× Medicare (16¢ 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 Fayette County Hospital
High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 105 published procedures.
| Procedure & Billing Code | This Hospital | vs. Fair |
|---|---|---|
| Digestive disorders treatment (inpatient stay) MS-DRG Code: 392 | $29,417 | 3.6× |
| Sepsis treatment (inpatient stay) MS-DRG Code: 871 | $23,487 | 1.2× |
| Rabies immune globulin HCPCS Code: 90375 | $8,084 | unverified |
| Total hip replacement CPT Code: 27130 | $5,861 | 0.4× |
| Total knee replacement CPT Code: 27447 | $5,408 | 0.4× |
| Sleep study (overnight, in lab) CPT Code: 95810 | $3,735 | 3.7× |
| Gallbladder removal (laparoscopic) CPT Code: 47562 | $1,203 | 0.2× |
| Ultrasound, leg veins (duplex) CPT Code: 93970 | $1,043 | 3.8× |
| Breast lump removal CPT Code: 19120 | $778 | 0.2× |
| Neurobehavioral status check CPT Code: 96116 | $592 | unverified |
| Knee arthroscopy with meniscus repair CPT Code: 29881 | $521 | 0.2× |
| Inguinal hernia repair CPT Code: 49505 | $531 | 0.1× |
| Group therapy session CPT Code: 90853 | $379 | unverified |
| X-ray, hip CPT Code: 73502 | $333 | 3.6× |
| X-ray, pelvis CPT Code: 72170 | $331 | 3.0× |
| Family therapy session CPT Code: 90847 | $332 | 1.9× |
| Psychotherapy session (60 minutes) CPT Code: 90837 | $304 | 1.7× |
| Colonoscopy (diagnostic) CPT Code: 45378 | $312 | 0.3× |
| Psychotherapy session (45 minutes) CPT Code: 90834 | $304 | unverified |
| Speech therapy (language evaluation) CPT Code: 92507 | $255 | unverified |
| MRI, brain (with and without contrast) CPT Code: 70553 | $214 | 0.4× |
| Upper endoscopy with biopsy CPT Code: 43239 | $232 | 0.2× |
| Colonoscopy with biopsy CPT Code: 45380 | $194 | 0.2× |
| CT scan, head (with and without contrast) CPT Code: 70470 | $140 | 0.5× |
| Echocardiogram (heart ultrasound) CPT Code: 93306 | $149 | 0.3× |
Audit a Bill or Quote at Fayette County Hospital (Zero PHI Required)
Statutory 501(r) AGB Cap Limits Bill to $10,140
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (34.5% of gross = $10,140).
Compare Prompt-Pay Cash Rate Against Remaining Deductible
Fayette County Hospital's published 45 CFR § 180 self-pay cash rate is $29,417 (vs. $29,417 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.
Negotiate Toward $8,223 Fair BaseRate ($5,676 Medicare)
Your bill ($29,417) is $21,194 above the denoised Fair BaseRate ($8,223) and 5.2× the $5,676 Medicare rate.
Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)
Hospital-Specific CMS HCRIS Benchmark (34.5% 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 (48 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 Fayette County Hospital.
Notable Payer Contract Outliers (SVD Matrix Anomalies)
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.