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Hospital Profile Acute Care Hospital Voluntary non-profit - Private 131 Beds · urban Updated: 3/25/2026

St Marys Hospital

1800 E Lake Shore Dr, Decatur, IL 62521 · 96 Priced Procedures · 60% Patient Recommendation

CMS Overall Rating 1 / 5 Stars
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
0.98×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 (0.98×) 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).83/100 · Corroborated
83/100Self-Pay Cash Beats Insurance 51% of the Time
File Completeness61Provenance (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 Logic91Coherence (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 Alignment80Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing86Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount100Cash 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 Rating3/5 StarsOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety Score64/100Composite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER Wait154 minMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.

3-Star CMS clinical quality rating paired with 0.98× fair market pricing.

Behavioral Pricing FingerprintConsistent Department Multiples

Aligned Regional Benchmark Peer

St Marys Hospital prices shoppable and inpatient services (1.1× to 1.1× Medicare, divergence 1.00×) in alignment with regional hospital peers (0.98× Fair BaseRate). Reviewing plan-specific negotiated rates and cash discounts helps lock in the lowest out-of-pocket tier.

#54 of 126 in IL · 42nd State Percentile#1,161 of 3,385 in U.S. · 34th National Percentile
Advantage

Where They're Good (Patient & Payer Edge)

  • Elective shoppable care is priced 2% below peer Fair BaseRate (0.98×)
  • Self-pay cash beats commercial insurance on 51% of shoppable procedures (99/100 Cash Honesty)
  • 1-Star CMS clinical rating with 60% patient recommendation (64/100 safety score)
  • IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (70.0% 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.
  • Even at low-cost facilities (0.98× 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.
  • Consolidated metro market (HHI 6,008) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))
Front-Door ShoppableElective / Imaging
1.1× Medicare

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

Back-Door Captive & ER1.00× Divergence
1.1× Medicare

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

Quantile Tail Spread+5% Upper Tail
Q25 0.89× · Q50 0.98× · Q75 1.03×

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
2.7× MedicareFair
Back-Door Captive ER VisitsBack-Door Captive
1.6× MedicareGood
Inpatient Lab & PathologyBack-Door Captive
4.0× MedicareElevated
Specialty & Infusion Drugs (J-Codes)Back-Door Captive
0.9× MedicareGood
Self-Pay Cash Honesty & 501(r)Integrity & Outcomes
51% Cash Edge · 99/100Good
CMS Clinical Safety & Star ValueIntegrity & Outcomes
1 CMS · 64/100Elevated

Procedure Prices at St Marys Hospital

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 96 published procedures.

Sort:
Audit a Bill & 501(r) Cap ↓
Procedure & Billing Code This Hospital vs. Fair
Sleep study (overnight, in lab)
CPT Code: 95810
 $920 0.9×
Injection procedure for pain management
HCPCS Code: G0260
 $775 0.9×
Echocardiogram (heart ultrasound)
CPT Code: 93306
 $586 1.0×
Rabies immune globulin
HCPCS Code: 90375
 $462 1.4×
Blood transfusion
CPT Code: 36430
 $473 0.9×
CT scan, abdomen and pelvis (with contrast)
CPT Code: 74177
 $374 0.8×
MRI, brain (with and without contrast)
CPT Code: 70553
 $388 0.8×
New patient office visit (30-44 min)
CPT Code: 99203
 $313 unverified
Office visit, established patient (20-29 min)
CPT Code: 99213
 $313 unverified
Office visit, established patient (30-39 min)
CPT Code: 99214
 $313 unverified
Ultrasound, leg veins (duplex)
CPT Code: 93970
 $256 0.9×
CT scan, abdomen and pelvis (no contrast)
CPT Code: 74176
 $256 0.8×
MRI, lower back (no contrast)
CPT Code: 72148
 $256 0.8×
MRI, brain (no contrast)
CPT Code: 70551
 $256 0.7×
MRI, knee or other leg joint
CPT Code: 73721
 $257 0.7×
Breathing treatment (nebulizer)
CPT Code: 94640
 $235 unverified
Psychotherapy session (45 minutes)
CPT Code: 90834
 $190 1.1×
Family therapy session
CPT Code: 90847
 $190 1.1×
Psychiatric evaluation (first visit)
CPT Code: 90791
 $200 1.1×
Psychotherapy session (60 minutes)
CPT Code: 90837
 $190 1.0×
CT scan, head (with contrast)
CPT Code: 70460
 $193 0.8×
CT scan, head (with and without contrast)
CPT Code: 70470
 $200 0.8×
Speech therapy (language evaluation)
CPT Code: 92507
 $162 unverified
Group therapy session
CPT Code: 90853
 $109 1.1×
X-ray, pelvis
CPT Code: 72170
 $112 1.0×
Showing top 25 high-impact procedures of 96 total
Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 70.0%

Audit a Bill or Quote at St Marys Hospital (Zero PHI Required)

CMS CCN: 140166
CPT 95810
Fair BaseRate™ $1,021
Medicare Rate $877
Self-Pay Cash $6,178
Insurer Median $920
Pre-filled with St Marys 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 501(r) AGB Cap: $6,007 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $6,007

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (70.0% of gross = $6,007).

Step 2 · Cash vs. Insurance Arbitrage Save $2,403 Paying Cash

Self-Pay Cash Rate ($6,178) Beats Your Bill

St Marys Hospital's published 45 CFR § 180 self-pay cash rate is $6,178 (vs. $920 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$7,560 Above Fair BaseRate

Negotiate Toward $1,021 Fair BaseRate ($877 Medicare)

Your bill ($8,581) is $7,560 above the denoised Fair BaseRate ($1,021) and 9.8× the $877 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 (70.0% 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 Overall3/5 Stars (3/5)
Safety Composite64/100
Would Recommend60%
Rated 9 or 10 (HCAHPS)64%
Median ER Wait154 min
Left ER Before Seen2%
30-Day Mortality vs U.S.same
Unplanned Readmissionsame

Healthcare-Associated Infections (CDC NHSN / CMS HAI)

1.00 SIR = National Predicted Baseline (Lower Is Safer)
C. diff Hospital-Onset Infectionsame

CMS Price Transparency Administrative Enforcement Log

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

  • 2025-04-17·administrative_or_closure

    Met Requirements

    Recorded

Source: CMS Hospital Care Compare (333 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 St Marys Hospital.

Price Index: 0.96× regional baseline
Quality: 54/100 CMS composite

Notable Payer Contract Outliers (SVD Matrix Anomalies)

Meridian
-56.8%
Blue Cross Blue Shield
-53.3%
Wexford
+131.6%
Median Household Income$62,449U.S. Census ACS
Local Uninsured Share4.1%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 83/100 · Corroborated CMS CCN 140166

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 140166) ↗ CMS HCRIS Cost Reports ↗
Published MRF FileCMS_45_CFR_180_FILING.json
Publication / Vintage3/25/2026
Validated Rate Rows4,980 (CMS v3.0.0)
File Integrity DigestVerified · CCN 140166

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