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Hospital Profile Critical Access Hospital Government - Hospital District or Authority 20 Beds · rural Updated: 2026-06-08

Pinckneyville Community Hospital

5383 State Route 154, Pinckneyville, IL 62274 · 104 Priced Procedures · 74% Patient Recommendation

CMS Overall Rating No CMS Rating
Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.Near Fair BaseRate Benchmark
1.00×vs. Fair Market Price
Position vs. 1.00× Fair PriceRight at U.S. Average (0%) 1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.

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

Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).47/100 · Quarantined
47/100Self-Pay Cash Beats Insurance 0% of the Time
File Completeness100Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic78Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment65Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing66Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount6Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.Regional Value Leader
CMS Star RatingNot RatedOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety Score71/100Composite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER Wait50 minMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.

Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.

Behavioral Pricing FingerprintConsistent Department Multiples

Aligned Regional Benchmark Peer

Pinckneyville Community Hospital prices shoppable and inpatient services (5.7× to 4.7× Medicare, divergence 0.82×) 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 0% of shoppable procedures (25/100 Cash Honesty)
  • CMS clinical safety score (71/100 safety score) with 74% patient recommendation
  • Binding Good Faith Estimate rights under 45 CFR § 149.610 protect self-pay patients before scheduling
Watchout

Where You Can Get Burned (Markup Traps)

  • Outpatient surgery & OR suites carry a 2.7× markup over Medicare rates
  • Commercial insurance median sits at 1.00× Fair BaseRate (5.7× 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 9.5× Medicare (20¢ true HCRIS cost per $1 gross)
Front-Door ShoppableElective / Imaging
5.7× Medicare

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

Back-Door Captive & ER0.82× Divergence
4.7× 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
5.7× MedicareWatchout
Outpatient Surgery & ORBack-Door Captive
2.7× MedicareFair
Diagnostic Imaging (CT/MRI)Front-Door Shoppable
3.5× MedicareElevated
Back-Door Captive ER VisitsBack-Door Captive
2.7× MedicareFair
Inpatient Lab & PathologyBack-Door Captive
4.3× MedicareElevated
Specialty & Infusion Drugs (J-Codes)Back-Door Captive
2.7× MedicareFair
Self-Pay Cash Honesty & 501(r)Integrity & Outcomes
0% Cash Edge · 25/100Watchout
CMS Clinical Safety & Star ValueIntegrity & Outcomes
3 CMS · 71/100Fair

Procedure Prices at Pinckneyville Community Hospital

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 104 published procedures.

Sort:
Audit a Bill & 501(r) Cap ↓
Procedure & Billing Code This Hospital vs. Fair
Sepsis treatment (inpatient stay)
MS-DRG Code: 871
 $27,246 1.4×
Digestive disorders treatment (inpatient stay)
MS-DRG Code: 392
 $18,860 2.3×
Gallbladder removal (laparoscopic)
CPT Code: 47562
 $9,640 1.6×
Inguinal hernia repair
CPT Code: 49505
 $7,899 2.2×
CT scan, abdomen and pelvis (with contrast)
CPT Code: 74177
 $5,160 11.5×
Cataract surgery with lens implant
CPT Code: 66984
 $4,427 unverified
Sleep study (overnight, in lab)
CPT Code: 95810
 $3,115 3.1×
CT scan, chest (no contrast)
CPT Code: 71250
 $3,052 18.3×
CT scan, abdomen and pelvis (no contrast)
CPT Code: 74176
 $2,662 8.8×
Colonoscopy with biopsy
CPT Code: 45380
 $2,582 2.1×
Upper endoscopy with biopsy
CPT Code: 43239
 $2,272 2.3×
MRI, lower back (no contrast)
CPT Code: 72148
 $2,235 6.6×
MRI, knee or other leg joint
CPT Code: 73721
 $1,951 5.3×
Colonoscopy (diagnostic)
CPT Code: 45378
 $1,882 1.9×
Echocardiogram (heart ultrasound)
CPT Code: 93306
 $1,821 3.1×
CT scan, lower back (lumbar spine)
CPT Code: 72131
 $1,760 10.5×
CT scan, neck (cervical spine)
CPT Code: 72125
 $1,765 10.4×
CT scan, head (with and without contrast)
CPT Code: 70470
 $1,745 6.8×
Ultrasound, leg veins (duplex)
CPT Code: 93970
 $1,701 6.3×
CT scan, head (with contrast)
CPT Code: 70460
 $1,648 6.8×
CT scan, sinuses
CPT Code: 70486
 $1,611 9.7×
Blood transfusion
CPT Code: 36430
 $1,635 3.3×
CT scan, pelvis
CPT Code: 72192
 $1,562 9.6×
CT scan, head (no contrast)
CPT Code: 70450
 $1,464 9.2×
MRI, brain (with and without contrast)
CPT Code: 70553
 $1,191 2.3×
Showing top 25 high-impact procedures of 104 total
Inline Bill X-Ray & 501(r) Calculator For-Profit Facility · Cash & Fair BaseRate Audit

Audit a Bill or Quote at Pinckneyville Community Hospital (Zero PHI Required)

CMS CCN: 141307
CPT 871
Fair BaseRate™ $19,087
Medicare Rate $14,117
Self-Pay Cash $27,246
Insurer Median $27,246
Pre-filled with Pinckneyville Community Hospital’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check 274% of 2026 FPL

Above Standard 400% FPL Financial-Assistance Ceiling

At 274% FPL, you exceed the standard 400% FPL tier, though medical-hardship caps (when bills exceed 10% of annual income) may still apply.

Step 2 · Cash vs. Insurance Arbitrage Published Cash: $27,246

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Pinckneyville Community Hospital's published 45 CFR § 180 self-pay cash rate is $27,246 (vs. $27,246 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$8,159 Above Fair BaseRate

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

Your bill ($27,246) is $8,159 above the denoised Fair BaseRate ($19,087) and 1.9× 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) For-Profit / Non-501(c)(3)

Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)

Public IRS & CMS ownership records classify Pinckneyville Community Hospital as a non-501(c)(3) facility. Federal 26 U.S.C. § 501(r) statutory charity-care caps apply specifically to tax-exempt nonprofit hospitals, though state hospital fair-pricing statutes and prompt-pay self-pay discounts may still apply.

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

Safety Composite71/100
Would Recommend74%
Rated 9 or 10 (HCAHPS)87%
Median ER Wait50 min
Left ER Before Seen0%
30-Day Mortality vs U.S.same
Unplanned Readmissionsame

Source: CMS Hospital Care Compare (80 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 Value & Quality Leader Pareto Frontier (Price + Quality)

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Pinckneyville Community Hospital.

Price Index: 0.54× regional baseline
Quality: 58/100 CMS composite
Median Household Income$59,286U.S. Census ACS
Local Uninsured Share3.7%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 47/100 · Quarantined CMS CCN 141307

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

Download Official Hospital MRF ↗ Verify on CMS Medicare.gov (CCN 141307) ↗ CMS HCRIS Cost Reports ↗
Published MRF Fileurl
Publication / Vintage2026-06-08 · 28.52 MB
Validated Rate Rows32 (CMS v3.0.0)
File Integrity Digestbcfa451b63b0926b62a3…

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