St Elizabeth Edgewood
1 Medical Village Drive, Edgewood, KY 41017 · 117 Priced Procedures · 74% Patient Recommendation
Typical commercial prices here match the fair market benchmark (1.02×) after accounting for local nurse/doctor wages and patient complexity.
4-Star CMS clinical quality rating paired with 1.02× fair market pricing.
Aligned Regional Benchmark Peer
St Elizabeth Edgewood prices shoppable and inpatient services (1.5× to 1.1× Medicare, divergence 0.73×) in alignment with regional hospital peers (1.02× Fair BaseRate). Reviewing plan-specific negotiated rates and cash discounts helps lock in the lowest out-of-pocket tier.
Where They're Good (Patient & Payer Edge)
- Bottom-quartile procedures (Q25) price at 0.97× the peer BaseRate benchmark
- Self-pay cash beats commercial insurance on 4% of shoppable procedures (25/100 Cash Honesty)
- 5-Star CMS clinical rating with 74% patient recommendation (73/100 safety score)
- IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (36.2% AGB cap)
Where You Can Get Burned (Markup Traps)
- Outpatient surgery & OR suites carry a 1.7× markup over Medicare rates
- Commercial insurance median sits at 1.04× Fair BaseRate (1.5× Medicare), so insured patients should always compare the self-pay cash price before paying.
- Upper-quartile procedures (Q75 1.30×) jump +25% above the median procedure ratio (Q50 1.04×)
- Unnegotiated chargemaster list prices average 3.3× Medicare (30¢ 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 St Elizabeth Edgewood
High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 117 published procedures.
| Procedure & Billing Code | This Hospital | vs. Fair |
|---|---|---|
| Spinal fusion, single level (inpatient stay) MS-DRG Code: 451 | $26,168 | 0.9× |
| Sepsis treatment (inpatient stay) MS-DRG Code: 871 | $15,949 | 0.8× |
| Hip or knee replacement (inpatient stay) MS-DRG Code: 470 | $15,841 | 0.8× |
| Heart stent placement (inpatient stay) MS-DRG Code: 322 | $14,525 | 0.8× |
| Total hip replacement CPT Code: 27130 | $13,556 | 1.0× |
| Total knee replacement CPT Code: 27447 | $13,556 | 1.0× |
| Gallbladder removal (laparoscopic) CPT Code: 47562 | $11,988 | 2.0× |
| Inguinal hernia repair CPT Code: 49505 | $7,490 | 2.1× |
| Knee arthroscopy with meniscus repair CPT Code: 29881 | $6,845 | 2.0× |
| Bunion correction surgery CPT Code: 28296 | $6,845 | 2.0× |
| Breast lump removal CPT Code: 19120 | $6,862 | 1.8× |
| Digestive disorders treatment (inpatient stay) MS-DRG Code: 392 | $6,722 | 0.8× |
| Cataract surgery with lens implant CPT Code: 66984 | $4,828 | 1.9× |
| Colonoscopy with biopsy CPT Code: 45380 | $2,503 | 2.0× |
| Colonoscopy (diagnostic) CPT Code: 45378 | $1,945 | unverified |
| Upper endoscopy with biopsy CPT Code: 43239 | $1,897 | unverified |
| Injection procedure for pain management HCPCS Code: G0260 | $1,477 | 1.7× |
| Sleep study (overnight, in lab) CPT Code: 95810 | $920 | 0.9× |
| Blood transfusion CPT Code: 36430 | $875 | 1.8× |
| Echocardiogram (heart ultrasound) CPT Code: 93306 | $747 | 1.3× |
| Family therapy session CPT Code: 90847 | $645 | 3.7× |
| Psychotherapy session (60 minutes) CPT Code: 90837 | $645 | 3.6× |
| CT scan, abdomen and pelvis (with contrast) CPT Code: 74177 | $533 | 1.2× |
| MRI, brain (with and without contrast) CPT Code: 70553 | $533 | 1.0× |
| Ultrasound, leg veins (duplex) CPT Code: 93970 | $457 | 1.7× |
Audit a Bill or Quote at St Elizabeth Edgewood (Zero PHI Required)
Statutory 501(r) AGB Cap Limits Bill to $22,735
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.2% of gross = $22,735).
Compare Prompt-Pay Cash Rate Against Remaining Deductible
Ask St Elizabeth Edgewood's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.
Negotiate Toward $30,775 Fair BaseRate ($23,504 Medicare)
Your bill ($62,803) is $32,028 above the denoised Fair BaseRate ($30,775) and 2.7× the $23,504 Medicare rate.
Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)
Hospital-Specific CMS HCRIS Benchmark (36.2% 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.
Clinical Quality, Patient Experience & Infection Benchmarks
Healthcare-Associated Infections (CDC NHSN / CMS HAI)
1.00 SIR = National Predicted Baseline (Lower Is Safer)Source: CMS Hospital Care Compare (2,900 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 St Elizabeth Edgewood.
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.