How many shoppable procedure prices are published for Paoli Hospital?

Paoli Hospital in Paoli, PA currently has 121 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do Paoli Hospital's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, Paoli Hospital's median negotiated commercial rate is 1.0× the regionally adjusted fair BaseRate benchmark.

What is Paoli Hospital's CMS Care Compare overall star rating?

CMS Care Compare assigns Paoli Hospital an overall hospital quality rating of 5 out of 5 stars based on public federal clinical and patient-experience measures.

Hospital Profile Acute Care Hospital Voluntary non-profit - Private 261 Beds · urban Updated: 2026-04-01

Paoli Hospital

255 West Lancaster Avenue, Paoli, PA 19301 · 121 Priced Procedures · 80% Patient Recommendation

CMS Overall Rating 5 / 5 Stars

Near Fair BaseRate Benchmark

1.00×vs. Fair Market Price

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

82/100 · Corroborated

82/100Self-Pay Cash Beats Insurance 15% of the Time

File Completeness56

Price Logic98

Peer Alignment70

Clean Billing86

Real Cash Discount100

Regional Value Leader

4-Star CMS clinical quality rating paired with 1.00× fair market pricing.

Behavioral Pricing FingerprintConsistent Department Multiples

Aligned Regional Benchmark Peer

Paoli Hospital prices shoppable and inpatient services (1.3× to 1.2× Medicare, divergence 0.92×) 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.

#77 of 134 in PA · 56th State Percentile#1,297 of 3,385 in U.S. · 38th National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Bottom-quartile procedures (Q25) price at 0.95× the peer BaseRate benchmark
Self-pay cash beats commercial insurance on 15% of shoppable procedures (99/100 Cash Honesty)
5-Star CMS clinical rating with 80% 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 (13.8% AGB cap)

Watchout

Where You Can Get Burned (Markup Traps)

Even at low-cost facilities (1.00× 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.
Commercial insurance median sits at 1.03× Fair BaseRate (1.3× Medicare), so insured patients should always compare the self-pay cash price before paying.
Specialty infusion drugs (J-codes) average 1.1× Medicare — verify per-unit billing on itemized statements
Unnegotiated chargemaster list prices average 11.7× Medicare (14¢ true HCRIS cost per $1 gross)

Front-Door ShoppableElective / Imaging

1.3× Medicare

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

Back-Door Captive & ER0.92× Divergence

1.2× Medicare

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

Quantile Tail Spread+8% Upper Tail

Q25 0.95× · Q50 1.03× · Q75 1.11×

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

1.3× MedicareGood

Outpatient Surgery & ORBack-Door Captive

0.6× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

2.0× MedicareGood

Back-Door Captive ER VisitsBack-Door Captive

1.0× MedicareGood

Inpatient Lab & PathologyBack-Door Captive

2.2× MedicareFair

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

1.1× MedicareGood

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

15% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

5 CMS · 75/100Fair

Procedure Prices at Paoli Hospital

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 121 published procedures.

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Audit a Bill & 501(r) Cap ↓

Procedure & Billing Code	Self-Pay Cash	This Hospital	Fair BaseRate	vs. Fair
Spinal fusion, single level (inpatient stay) MS-DRG Code: `451`	—	$26,025	$30,775	0.8×
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	—	$15,649	$19,087	0.8×
Hip or knee replacement (inpatient stay) MS-DRG Code: `470`	—	$15,540	$19,432	0.8×
Heart stent placement (inpatient stay) MS-DRG Code: `322`	—	$14,203	$17,936	0.8×
Total hip replacement CPT Code: `27130`	—	$13,652	$13,413	1.0×
Total knee replacement CPT Code: `27447`	—	$13,652	$13,523	1.0×
Gallbladder removal (laparoscopic) CPT Code: `47562`	—	$6,944	$6,109	1.1×
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	—	$6,281	$8,223	0.8×
Breast lump removal CPT Code: `19120`	—	$4,405	$3,875	1.1×
Inguinal hernia repair CPT Code: `49505`	$3,158	$4,112	$3,629	1.1×
Knee arthroscopy with meniscus repair CPT Code: `29881`	—	$3,758	$3,372	1.1×
Bunion correction surgery CPT Code: `28296`	—	$3,758	$3,446	1.1×
Cataract surgery with lens implant CPT Code: `66984`	—	$2,651	$2,540	1.0×
Trauma team activation HCPCS Code: `G0390`	$3,130	$1,499	$1,453	1.0×
Colonoscopy with biopsy CPT Code: `45380`	$1,570	$1,374	$1,256	1.1×
Colonoscopy (diagnostic) CPT Code: `45378`	$1,240	$1,068	$981	1.1×
Upper endoscopy with biopsy CPT Code: `43239`	$1,467	$1,042	$987	1.1×
Sleep study (overnight, in lab) CPT Code: `95810`	$2,989	$979	$1,021	1.0×
Injection procedure for pain management HCPCS Code: `G0260`	—	$811	$855	0.9×
Echocardiogram (heart ultrasound) CPT Code: `93306`	$1,958	$628	$583	1.1×
Psychological testing by technician CPT Code: `96138`	—	$491	$395	1.2×
Blood transfusion CPT Code: `36430`	$748	$507	$498	1.0×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$2,236	$425	$448	0.9×
MRI, brain (with and without contrast) CPT Code: `70553`	$2,183	$425	$511	0.8×
Rabies immune globulin HCPCS Code: `90375`	$6,565	$308	$322	1.0×
Breathing treatment (nebulizer) CPT Code: `94640`	$157	$250	$201	1.2×
Ultrasound, leg veins (duplex) CPT Code: `93970`	$1,333	$274	$272	1.0×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$1,431	$285	$303	0.9×
MRI, lower back (no contrast) CPT Code: `72148`	$1,790	$290	$338	0.9×
MRI, brain (no contrast) CPT Code: `70551`	$1,331	$290	$343	0.8×
MRI, knee or other leg joint CPT Code: `73721`	$1,642	$290	$369	0.8×
Neurobehavioral status check CPT Code: `96116`	—	$246	$231	1.1×
CT scan, head (with contrast) CPT Code: `70460`	$854	$214	$242	0.9×
CT scan, head (with and without contrast) CPT Code: `70470`	$1,000	$214	$258	0.8×
Electrocardiogram (ECG/EKG) CPT Code: `93000`	—	$211	$25	unverified
Group therapy session CPT Code: `90853`	$150	$150	$100	1.5×
Psychological testing evaluation CPT Code: `96136`	—	$146	$128	1.1×
Hepatitis B immune globulin HCPCS Code: `90371`	$1,424	$148	$151	1.0×
Psychiatric evaluation (first visit) CPT Code: `90791`	$170	$170	$185	0.9×
Psychotherapy session (60 minutes) CPT Code: `90837`	$149	$149	$181	0.8×
Hospital observation (per hour) HCPCS Code: `G0378`	$120	$120	$86	1.4×
X-ray, pelvis CPT Code: `72170`	$190	$111	$110	1.0×
Ultrasound, abdomen (limited) CPT Code: `76705`	$403	$127	$126	1.0×
Ultrasound, pelvis CPT Code: `76856`	$447	$127	$130	1.0×
Ultrasound, thyroid and neck CPT Code: `76536`	$406	$127	$132	1.0×
Ultrasound, abdomen (complete) CPT Code: `76700`	$540	$127	$134	0.9×
Diagnostic mammogram (both breasts) CPT Code: `77066`	$258	$137	$148	0.9×
Screening mammogram (both breasts) CPT Code: `77067`	$272	$113	$123	0.9×
CT scan, head (no contrast) CPT Code: `70450`	$606	$127	$160	0.8×
CT scan, pelvis CPT Code: `72192`	$1,094	$127	$163	0.8×
CT scan, sinuses CPT Code: `70486`	$937	$127	$166	0.8×
CT scan, chest (no contrast) CPT Code: `71250`	$1,090	$127	$167	0.8×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$900	$127	$168	0.8×
CT scan, neck (cervical spine) CPT Code: `72125`	$730	$127	$169	0.8×
X-ray, chest (single view) CPT Code: `71045`	$156	$97	$92	1.1×
X-ray, chest (two views) CPT Code: `71046`	$240	$97	$93	1.0×
X-ray, shoulder CPT Code: `73030`	$285	$95	$92	1.0×
X-ray, foot CPT Code: `73630`	$452	$93	$92	1.0×
X-ray, hand CPT Code: `73130`	$216	$93	$93	1.0×
X-ray, neck (cervical spine) CPT Code: `72040`	$286	$97	$93	unverified
X-ray, lower back CPT Code: `72110`	$345	$120	$112	unverified
X-ray, ankle CPT Code: `73610`	$481	$93	$93	1.0×
Speech therapy (language evaluation) CPT Code: `92507`	$343	$82	$86	1.0×
Psychotherapy session (45 minutes) CPT Code: `90834`	$100	$100	$166	0.6×
Family therapy session CPT Code: `90847`	$88	$88	$173	0.5×
X-ray, hip CPT Code: `73502`	$206	$98	$93	unverified
Typhoid vaccine HCPCS Code: `90675`	$958	$345	$347	1.0×
Varicella (chickenpox) vaccine HCPCS Code: `90716`	$495	$209	$203	1.0×
Drug screening test HCPCS Code: `G0480`	$67	$126	$116	1.1×
Pneumococcal vaccine HCPCS Code: `90732`	$354	$136	$140	1.0×
Blood antibody screen CPT Code: `86850`	$42	$54	$46	1.2×
Flu vaccine injection HCPCS Code: `G0008`	$38	$53	$48	1.1×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$153	$61	$56	1.1×
Colorectal cancer screening (alternative) HCPCS Code: `G0145`	$51	$31	$27	1.1×
Pneumonia vaccine injection HCPCS Code: `G0009`	$64	$53	$49	1.1×
Colorectal cancer screening HCPCS Code: `G0010`	$64	$53	$49	1.1×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$261	$68	$64	1.1×
Prostate cancer screening (blood test) HCPCS Code: `G0103`	$98	$23	$20	1.1×
Blood test, vitamin D CPT Code: `82306`	$65	$35	$31	1.1×
Hepatitis B vaccine HCPCS Code: `90744`	$87	$38	$37	1.0×
Prosthetic fitting and training CPT Code: `97761`	$64	$46	$45	1.0×
Orthotic fitting and training CPT Code: `97760`	$88	$49	$51	1.0×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$28	$4	$3	1.3×
Blood test, glucose (blood sugar) CPT Code: `82947`	$15	$5	$4	1.3×
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$14	$5	$4	1.3×
Blood test, calcium CPT Code: `82310`	$15	$6	$5	1.2×
Blood test, creatinine (kidney) CPT Code: `82565`	$20	$6	$5	1.2×
Blood test, average blood sugar (A1c) CPT Code: `83036`	$41	$12	$10	1.2×
Blood test, comprehensive metabolic panel CPT Code: `80053`	$172	$13	$11	1.2×
Blood test, clotting time (PTT) CPT Code: `85730`	$46	$7	$6	1.2×
Flu vaccine (high dose) HCPCS Code: `90656`	$80	$29	$25	1.2×
Blood test, PSA (prostate screen) CPT Code: `84153`	$89	$22	$19	1.2×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$103	$16	$14	1.1×
Blood test, amylase CPT Code: `82150`	$40	$8	$7	1.1×
Blood test, ferritin (iron stores) CPT Code: `82728`	$80	$16	$14	1.1×
Electrical stimulation therapy HCPCS Code: `G0283`	$107	$15	$14	1.1×
Physical therapy (functional capacity test) CPT Code: `97750`	$71	$39	$38	1.0×
DTaP vaccine (diphtheria, tetanus, pertussis) HCPCS Code: `90700`	$102	$40	$39	1.0×
Blood test, lipase CPT Code: `83690`	$41	$8	$7	1.1×
Blood test, magnesium CPT Code: `83735`	$36	$8	$7	1.1×
Hepatitis C antibody test CPT Code: `86803`	$96	$17	$15	1.1×
Blood test, vitamin B12 CPT Code: `82607`	$87	$18	$16	1.1×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$77	$40	$40	1.0×
Blood test, complete blood count (CBC) CPT Code: `85025`	$40	$9	$8	1.1×
Blood test, thyroid (TSH) CPT Code: `84443`	$87	$20	$18	1.1×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$82	$38	$38	1.0×
Blood test, basic metabolic panel CPT Code: `80048`	$102	$10	$9	1.1×
Blood test, liver function panel CPT Code: `80076`	$92	$10	$9	1.1×
Culture, bacterial CPT Code: `87070`	$117	$10	$9	1.1×
Culture, blood CPT Code: `87040`	$85	$12	$11	1.1×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$80	$33	$35	0.9×
Physical therapy (manual therapy) CPT Code: `97140`	$82	$32	$34	0.9×
Physical therapy (gait training) CPT Code: `97116`	$107	$31	$33	0.9×
Occupational therapy (self-care training) CPT Code: `97535`	$77	$34	$38	0.9×
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	$33	$33	$111	0.3×
Blood test, potassium CPT Code: `84132`	$15	$5	$5	1.0×
Blood test, sodium CPT Code: `84295`	$15	$5	$5	1.0×
Blood test, hemoglobin CPT Code: `85018`	$19	$3	$3	1.0×
Blood test, clotting time (PT/INR) CPT Code: `85610`	$22	$5	$5	1.0×
Speech therapy (group session) CPT Code: `92508`	$99	$26	$27	1.0×
Diagnostic procedure preparation HCPCS Code: `G0279`	$208	$13	$35	0.4×

Showing top 25 high-impact procedures of 121 total

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 13.8%

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

CMS CCN: 390153

CPT 451

Select Procedure to Audit:

Fair BaseRate™ $30,775

Medicare Rate $23,504

Self-Pay Cash Request Quote

Insurer Median $26,025

1. Amount on Your Bill or Quote ($) Pre-filled with Paoli 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: $8,588 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $8,588

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (13.8% of gross = $8,588).

Step 2 · Cash vs. Insurance Arbitrage Request Prompt-Pay Quote

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask Paoli Hospital's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.

Step 3 · Fair BaseRate Target +$31,685 Above Fair BaseRate

Negotiate Toward $30,775 Fair BaseRate ($23,504 Medicare)

Your bill ($62,460) is $31,685 above the denoised Fair BaseRate ($30,775) and 2.7× the $23,504 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 (13.8% 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 Recommend80%

Rated 9 or 10 (HCAHPS)75%

Median ER Wait215 min

Left ER Before Seen0%

30-Day Mortality vs U.S.better

Unplanned Readmissionsame

Hip/Knee Complication Rate2.9%

Healthcare-Associated Infections (CDC NHSN / CMS HAI)

1.00 SIR = National Predicted Baseline (Lower Is Safer)

Central-Line Bloodstream Infectionsame

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 Paoli Hospital. Prior administrative notices do not necessarily reflect current compliance status.

2025-06-18·administrative_or_closure
Closure Notice
Recorded
2025-06-11·warning_notice
Warning Notice
Recorded

Source: CMS Hospital Care Compare (2,056 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 Paoli Hospital.

Price Index: 0.88× regional baseline

Quality: 86/100 CMS composite

Median Household Income$123,041U.S. Census ACS

Local Uninsured Share4.4%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 390153

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 390153) ↗ CMS HCRIS Cost Reports ↗

Published MRF FileCMS_45_CFR_180_FILING.json

Publication / Vintage2026-04-01

Validated Rate Rows1,880 (CMS v3.0.0)

File Integrity DigestVerified · CCN 390153

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