How many shoppable procedure prices are published for HSHS St Elizabeth's Hospital?

HSHS St Elizabeth's Hospital in O Fallon, IL currently has 109 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do HSHS St Elizabeth's Hospital's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, HSHS St Elizabeth's Hospital's median negotiated commercial rate is 1.1× the regionally adjusted fair BaseRate benchmark.

What is HSHS St Elizabeth's Hospital's CMS Care Compare overall star rating?

CMS Care Compare assigns HSHS St Elizabeth's Hospital 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 - Church 144 Beds · urban Updated: 2026-01-15

HSHS St Elizabeth's Hospital

One St Elizabeth Boulevard, O Fallon, IL 62269 · 109 Priced Procedures · 79% Patient Recommendation

CMS Overall Rating 4 / 5 Stars

Near Fair BaseRate Benchmark

1.05×vs. Fair Market Price

Typical commercial prices here are +5% above the fair benchmark (1.05×) even after accounting for local nurse/doctor wages and patient complexity.

82/100 · Corroborated

82/100Self-Pay Cash Beats Insurance 53% of the Time

File Completeness61

Price Logic83

Peer Alignment81

Clean Billing90

Real Cash Discount100

Regional Value Leader

4-Star CMS clinical quality rating paired with 1.05× fair market pricing.

Behavioral Pricing FingerprintHigh Insurer Rate · Deep Cash Discount

Cash-Arbitrage Bifurcated Pricer

HSHS St Elizabeth's Hospital maintains elevated commercial insurance contracts (1.05× Fair BaseRate) while offering direct self-pay cash discounts that beat commercial negotiated medians on 53% of procedures. High-deductible and uninsured patients should always request the self-pay cash rate prior to billing.

#68 of 126 in IL · 53rd State Percentile#1,510 of 3,385 in U.S. · 44th National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Bottom-quartile procedures (Q25) price at 0.86× the peer BaseRate benchmark
Self-pay cash beats commercial insurance on 53% of shoppable procedures (99/100 Cash Honesty)
4-Star CMS clinical rating with 79% 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 (44.5% AGB cap)

Watchout

Where You Can Get Burned (Markup Traps)

Outpatient surgery & OR suites carry a 1.4× markup over Medicare rates
Commercial insurance median sits at 0.98× Fair BaseRate (1.1× Medicare), so insured patients should always compare the self-pay cash price before paying.
Specialty infusion drugs (J-codes) average 1.6× Medicare — verify per-unit billing on itemized statements
Unnegotiated chargemaster list prices average 11.8× Medicare (18¢ true HCRIS cost per $1 gross)

Front-Door ShoppableElective / Imaging

1.1× Medicare

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

Back-Door Captive & ER0.91× Divergence

1.0× Medicare

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

Quantile Tail Spread+6% Upper Tail

Q25 0.86× · Q50 0.98× · Q75 1.04×

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

1.1× MedicareGood

Outpatient Surgery & ORBack-Door Captive

1.4× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

2.2× MedicareFair

Back-Door Captive ER VisitsBack-Door Captive

1.6× MedicareGood

Inpatient Lab & PathologyBack-Door Captive

2.7× MedicareFair

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

1.6× MedicareGood

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

53% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

4 CMS · 75/100Fair

Procedure Prices at HSHS St Elizabeth's Hospital

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 109 published procedures.

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Audit a Bill & 501(r) Cap ↓

Procedure & Billing Code	Self-Pay Cash	This Hospital	Fair BaseRate	vs. Fair
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	$28,241	$16,374	$19,087	0.9×
Hip or knee replacement (inpatient stay) MS-DRG Code: `470`	$42,382	$16,259	$19,432	0.8×
Total hip replacement CPT Code: `27130`	$13,706	$14,365	$13,413	1.1×
Total knee replacement CPT Code: `27447`	$12,676	$14,365	$13,523	1.1×
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	$17,335	$6,774	$8,223	0.8×
Inguinal hernia repair CPT Code: `49505`	$7,503	$6,646	$3,629	unverified
Gallbladder removal (laparoscopic) CPT Code: `47562`	$10,025	$6,514	$6,109	1.1×
Breast lump removal CPT Code: `19120`	$7,302	$4,275	$3,875	1.1×
Knee arthroscopy with meniscus repair CPT Code: `29881`	$5,598	$3,622	$3,372	1.1×
Bunion correction surgery CPT Code: `28296`	$4,251	$3,622	$3,446	1.1×
Cataract surgery with lens implant CPT Code: `66984`	$2,094	$2,546	$2,540	1.0×
Colonoscopy with biopsy CPT Code: `45380`	$2,282	$1,316	$1,256	1.0×
Upper endoscopy with biopsy CPT Code: `43239`	$2,070	$1,047	$987	1.1×
Colonoscopy (diagnostic) CPT Code: `45378`	$2,259	$1,018	$981	1.0×
Sleep study (overnight, in lab) CPT Code: `95810`	$4,266	$915	$1,021	0.9×
Injection procedure for pain management HCPCS Code: `G0260`	$3,846	$773	$855	0.9×
Echocardiogram (heart ultrasound) CPT Code: `93306`	$4,004	$582	$583	1.0×
Blood transfusion CPT Code: `36430`	$1,220	$488	$498	1.0×
Rabies immune globulin HCPCS Code: `90375`	$1,176	$367	$322	1.1×
MRI, brain (with and without contrast) CPT Code: `70553`	$4,816	$389	$511	0.8×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$4,844	$357	$448	0.8×
New patient office visit (30-44 min) CPT Code: `99203`	$282	$327	$110	3.0×
Office visit, established patient (30-39 min) CPT Code: `99214`	$310	$327	$123	2.7×
Office visit, established patient (20-29 min) CPT Code: `99213`	$243	$327	$87	unverified
Ultrasound, leg veins (duplex) CPT Code: `93970`	$1,581	$270	$272	1.0×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$3,533	$268	$303	0.9×
Breathing treatment (nebulizer) CPT Code: `94640`	$255	$233	$201	1.2×
MRI, brain (no contrast) CPT Code: `70551`	$3,201	$254	$343	0.7×
MRI, knee or other leg joint CPT Code: `73721`	$3,457	$270	$369	0.7×
MRI, lower back (no contrast) CPT Code: `72148`	$2,986	$230	$338	0.7×
CT scan, head (with contrast) CPT Code: `70460`	$2,199	$199	$242	0.8×
CT scan, head (with and without contrast) CPT Code: `70470`	$2,547	$200	$258	0.8×
Hepatitis B immune globulin HCPCS Code: `90371`	$1,673	$138	$151	0.9×
Speech therapy (language evaluation) CPT Code: `92507`	$332	$155	$86	unverified
Hospital observation (per hour) HCPCS Code: `G0378`	$100	$100	$86	1.2×
X-ray, pelvis CPT Code: `72170`	$354	$119	$110	1.1×
X-ray, lower back CPT Code: `72110`	$890	$111	$112	1.0×
Ultrasound, pelvis CPT Code: `76856`	$1,434	$119	$130	0.9×
Ultrasound, abdomen (complete) CPT Code: `76700`	$1,164	$119	$134	0.9×
Ultrasound, abdomen (limited) CPT Code: `76705`	$1,277	$111	$126	0.9×
Ultrasound, thyroid and neck CPT Code: `76536`	$1,045	$111	$132	0.8×
CT scan, head (no contrast) CPT Code: `70450`	$1,846	$119	$160	0.7×
CT scan, pelvis CPT Code: `72192`	$2,059	$119	$163	0.7×
CT scan, sinuses CPT Code: `70486`	$2,197	$119	$166	0.7×
CT scan, chest (no contrast) CPT Code: `71250`	$2,224	$119	$167	0.7×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$2,558	$119	$168	0.7×
CT scan, neck (cervical spine) CPT Code: `72125`	$2,625	$119	$169	0.7×
X-ray, chest (single view) CPT Code: `71045`	$314	$93	$92	1.0×
X-ray, shoulder CPT Code: `73030`	$482	$93	$92	1.0×
X-ray, foot CPT Code: `73630`	$448	$93	$92	1.0×
X-ray, neck (cervical spine) CPT Code: `72040`	$594	$93	$93	1.0×
X-ray, hand CPT Code: `73130`	$436	$93	$93	1.0×
X-ray, hip CPT Code: `73502`	$227	$93	$93	1.0×
X-ray, ankle CPT Code: `73610`	$425	$93	$93	1.0×
X-ray, chest (two views) CPT Code: `71046`	$457	$88	$93	0.9×
Diagnostic mammogram (both breasts) CPT Code: `77066`	$556	$99	$148	0.7×
Screening mammogram (both breasts) CPT Code: `77067`	$488	$82	$123	0.7×
Typhoid vaccine HCPCS Code: `90675`	$1,502	$320	$347	0.9×
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	$685	$188	$111	1.7×
Drug screening test HCPCS Code: `G0480`	$173	$117	$116	1.0×
Flu vaccine (high dose) HCPCS Code: `90656`	$146	$38	$25	1.5×
Hepatitis B vaccine HCPCS Code: `90744`	$204	$55	$37	1.5×
Speech therapy (group session) CPT Code: `92508`	$94	$34	$27	1.3×
Blood antibody screen CPT Code: `86850`	$120	$56	$46	1.2×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$340	$65	$56	1.2×
Flu vaccine injection HCPCS Code: `G0008`	$78	$52	$48	1.1×
Pneumonia vaccine injection HCPCS Code: `G0009`	$77	$52	$49	1.1×
Colorectal cancer screening HCPCS Code: `G0010`	$77	$52	$49	1.1×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$322	$63	$64	1.0×
Electrical stimulation therapy HCPCS Code: `G0283`	$172	$25	$14	1.8×
Blood test, comprehensive metabolic panel CPT Code: `80053`	$191	$11	$11	1.0×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$175	$14	$14	1.0×
Blood test, creatinine (kidney) CPT Code: `82565`	$179	$5	$5	1.0×
Blood test, ferritin (iron stores) CPT Code: `82728`	$156	$14	$14	1.0×
Prostate cancer screening (blood test) HCPCS Code: `G0103`	$247	$20	$20	1.0×
Blood test, vitamin D CPT Code: `82306`	$154	$30	$31	1.0×
Colorectal cancer screening (alternative) HCPCS Code: `G0145`	$225	$26	$27	1.0×
Physical therapy (manual therapy) CPT Code: `97140`	$152	$31	$34	0.9×
Prosthetic fitting and training CPT Code: `97761`	$160	$41	$45	0.9×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$162	$33	$38	0.9×
Physical therapy (functional capacity test) CPT Code: `97750`	$125	$33	$38	0.9×
Orthotic fitting and training CPT Code: `97760`	$120	$44	$51	0.9×
Occupational therapy (self-care training) CPT Code: `97535`	$103	$31	$38	0.8×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$116	$3	$3	1.0×
Blood test, calcium CPT Code: `82310`	$77	$5	$5	1.0×
Blood test, glucose (blood sugar) CPT Code: `82947`	$63	$4	$4	1.0×
Blood test, average blood sugar (A1c) CPT Code: `83036`	$94	$10	$10	1.0×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$132	$34	$40	0.8×
Blood test, lipase CPT Code: `83690`	$122	$7	$7	1.0×
Blood test, magnesium CPT Code: `83735`	$89	$7	$7	1.0×
Blood test, potassium CPT Code: `84132`	$45	$5	$5	1.0×
Blood test, PSA (prostate screen) CPT Code: `84153`	$184	$19	$19	1.0×
Blood test, sodium CPT Code: `84295`	$63	$5	$5	1.0×
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$66	$4	$4	1.0×
Blood test, complete blood count (CBC) CPT Code: `85025`	$73	$8	$8	1.0×
Blood test, clotting time (PTT) CPT Code: `85730`	$60	$6	$6	1.0×
Culture, bacterial CPT Code: `87070`	$104	$9	$9	1.0×
Blood test, thyroid (TSH) CPT Code: `84443`	$139	$17	$18	0.9×
Blood test, vitamin B12 CPT Code: `82607`	$179	$15	$16	0.9×
Hepatitis C antibody test CPT Code: `86803`	$134	$14	$15	0.9×
Culture, blood CPT Code: `87040`	$161	$10	$11	0.9×
Blood test, basic metabolic panel CPT Code: `80048`	$194	$8	$9	0.9×
Blood test, liver function panel CPT Code: `80076`	$170	$8	$9	0.9×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$114	$31	$35	0.9×
Blood test, amylase CPT Code: `82150`	$89	$6	$7	0.9×
Physical therapy (gait training) CPT Code: `97116`	$131	$28	$33	0.8×
Blood test, clotting time (PT/INR) CPT Code: `85610`	$52	$4	$5	0.8×
Blood test, hemoglobin CPT Code: `85018`	$31	$2	$3	0.7×
Diagnostic procedure preparation HCPCS Code: `G0279`	$97	$14	$35	0.4×

Showing top 25 high-impact procedures of 109 total

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 44.5%

Audit a Bill or Quote at HSHS St Elizabeth's Hospital (Zero PHI Required)

CMS CCN: 140187

CPT 871

Select Procedure to Audit:

Fair BaseRate™ $19,087

Medicare Rate $14,117

Self-Pay Cash $28,241

Insurer Median $16,374

1. Amount on Your Bill or Quote ($) Pre-filled with HSHS St Elizabeth's 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: $17,439 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $17,439

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (44.5% of gross = $17,439).

Step 2 · Cash vs. Insurance Arbitrage Save $10,982 Paying Cash

Self-Pay Cash Rate ($28,241) Beats Your Bill

HSHS St Elizabeth's Hospital's published 45 CFR § 180 self-pay cash rate is $28,241 (vs. $16,374 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$20,136 Above Fair BaseRate

Negotiate Toward $19,087 Fair BaseRate ($14,117 Medicare)

Your bill ($39,223) is $20,136 above the denoised Fair BaseRate ($19,087) and 2.8× the $14,117 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 (44.5% 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.

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 Recommend79%

Rated 9 or 10 (HCAHPS)79%

Median ER Wait156 min

Left ER Before Seen0%

30-Day Mortality vs U.S.same

Unplanned Readmissionsame

Hip/Knee Complication Rate3.7%

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

CMS Price Transparency Administrative Enforcement Log

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

2024-11-04·administrative_or_closure
Met Requirements
Recorded

Source: CMS Hospital Care Compare (411 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

Higher-Quality, Above-Median Price Tier

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for HSHS St Elizabeth's Hospital.

Price Index: 1.26× regional baseline

Quality: 79/100 CMS composite

Notable Payer Contract Outliers (SVD Matrix Anomalies)

Meridian

-50.4%

Median Household Income$70,178U.S. Census ACS

Local Uninsured Share5.4%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 82/100 · Corroborated CMS CCN 140187

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 140187) ↗ CMS HCRIS Cost Reports ↗

Published MRF FileCMS_45_CFR_180_FILING.json

Publication / Vintage2026-01-15

Validated Rate Rows11,263 (CMS v2.2.0)

File Integrity DigestVerified · CCN 140187

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