Illinois / Presence Saint Joseph Hospital - Elgin
CMS certification 140217 · Elgin, IL
Presence Saint Joseph Hospital - Elgin: charges and Medicare payments
Presence Saint Joseph Hospital - Elgin reported 473 Medicare inpatient stays across 17 DRGs in 2024. Across them it charged 6.12 times what it was paid — among the higher ratios in Illinois, number 7 of 106 hospitals with at least 100 stays (state median 4.06×, national 4.15×). Its most frequent stay was DRG 871, Septicemia or Severe Sepsis without MV >96 Hours with MCC: 110 stays at an average charge of $84,562, 6% below the national average. It also billed 705 outpatient services, charging 10.45 times what Medicare paid.
- 1Medicare inpatient stays 473
- 2Charge ÷ paid, inpatient 6.12×
- 3Rank in IL (highest ratio = 1) 7 of 106
- 4CMS price-transparency actions 0
Inpatient stays
For the 17 DRGs that can be compared with the national average, Presence Saint Joseph Hospital - Elgin charged more than the national average in 13 (76%). Payments follow Medicare's rates, so they usually vary far less than charges.
| DRG | Stays | Avg charge | vs US | Avg paid |
|---|---|---|---|---|
| 871 Septicemia or Severe Sepsis without MV >96 Hours with MCC | 110 | $84,562 | -6% | $14,830 |
| 885 Psychoses | 49 | $70,661 | +60% | $14,592 |
| 291 Heart Failure and Shock with MCC | 42 | $55,490 | -2% | $10,254 |
| 193 Simple Pneumonia and Pleurisy with MCC | 39 | $70,410 | +18% | $10,642 |
| 189 Pulmonary Edema and Respiratory Failure | 29 | $66,280 | +15% | $10,459 |
| 177 Respiratory Infections and Inflammations with MCC | 26 | $71,235 | +1% | $12,411 |
| 280 Acute Myocardial Infarction, Discharged Alive with MCC | 23 | $88,749 | +17% | $13,100 |
| 483 Major Joint or Limb Reattachment Procedures of Upper... | 23 | $151,622 | +20% | $19,407 |
| 683 Renal Failure with CC | 23 | $51,854 | +27% | $7,651 |
| 698 Other Kidney and Urinary Tract Diagnoses with MCC | 20 | $96,036 | +31% | $13,116 |
| 392 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 16 | $49,044 | +22% | $6,704 |
| 682 Renal Failure with MCC | 15 | $57,052 | -13% | $11,769 |
| 309 Cardiac Arrhythmia and Conduction Disorders with CC | 13 | $44,430 | +23% | $9,075 |
| 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC | 12 | $58,862 | +20% | $8,537 |
| 065 Intracranial Hemorrhage or Cerebral Infarction with CC or... | 11 | $72,660 | +30% | $8,209 |
| 389 Gastrointestinal Obstruction with CC | 11 | $53,505 | +37% | $6,601 |
| 460 Spinal Fusion except Cervical without MCC | 11 | $160,283 | -6% | $24,577 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Level 5 Musculoskeletal Procedures | 190 | $118,589 | $12,778 |
| Comprehensive Observation Services | 87 | $31,183 | $2,649 |
| Level 4 Musculoskeletal Procedures | 83 | $72,854 | $6,922 |
| Level 6 Musculoskeletal Procedures | 54 | $150,650 | $18,164 |
| Level 1 Intraocular Procedures | 51 | $21,812 | $2,276 |
| Level 3 Electrophysiologic Procedures | 39 | $153,708 | $22,588 |
| Level 3 Vascular Procedures | 31 | $26,151 | $3,013 |
| Level 2 Excision/ Biopsy/ Incision and Drainage | 30 | $17,829 | $1,584 |
| Level 3 Musculoskeletal Procedures | 26 | $43,563 | $3,162 |
| Level 2 Upper GI Procedures | 23 | $18,271 | $1,794 |
| Level 1 Laparoscopy and Related Services | 20 | $77,324 | $5,637 |
| Level 4 Urology and Related Services | 17 | $35,195 | $3,406 |
| Level 2 Endovascular Procedures | 16 | $22,309 | $5,583 |
| Level 1 Endovascular Procedures | 14 | $40,847 | $3,188 |
| Level 3 Airway Endoscopy | 13 | $15,603 | $1,658 |
| Level 4 Airway Endoscopy | 11 | $13,474 | $3,658 |
Against the Illinois average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Presence Saint Joseph Hospital - Elgin charged $84,562 on average, 14% more than the Illinois average of $73,987, and was paid $14,830 against a state average of $17,651. For Psychoses (DRG 885), Presence Saint Joseph Hospital - Elgin charged $70,661 on average, 128% more than the Illinois average of $30,984, and was paid $14,592 against a state average of $12,483. For Heart Failure and Shock with MCC (DRG 291), Presence Saint Joseph Hospital - Elgin charged $55,490 on average, 20% more than the Illinois average of $46,293, and was paid $10,254 against a state average of $11,813. For Simple Pneumonia and Pleurisy with MCC (DRG 193), Presence Saint Joseph Hospital - Elgin charged $70,410 on average, 43% more than the Illinois average of $49,081, and was paid $10,642 against a state average of $11,857. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $118,589 was 77% above the state average of $67,146. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $31,183 was 45% above the state average of $21,498. For Level 4 Musculoskeletal Procedures (outpatient APC 5114), its average charge of $72,854 was 62% above the state average of $45,012. For Level 6 Musculoskeletal Procedures (outpatient APC 5116), its average charge of $150,650 was 57% above the state average of $95,905.
Price-transparency record
No action in CMS's price-transparency enforcement list (July 2026) matches this hospital's exact name, city and state. That can mean CMS has not reviewed it, or that it is listed under a different name.
Charges are the hospital's list prices averaged over its 2024 Medicare cases; payments are what those cases actually brought in. Neither is what you will pay. For a planned procedure, ask the hospital for its price estimate or, if you are uninsured or self-paying, a good-faith estimate.
Sources: CMS Medicare Inpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Medicare Outpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Hospital Price Transparency Enforcement Activities and Outcomes, July 2026. Checked 2026-10-24. Methodology.