How many shoppable procedure prices are published for Carle Foundation Hospital?

Carle Foundation Hospital in Urbana, IL currently has 142 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

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

Across scored shoppable procedures, Carle Foundation Hospital's median negotiated commercial rate is 0.9× the regionally adjusted fair BaseRate benchmark.

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

CMS Care Compare assigns Carle Foundation Hospital an overall hospital quality rating of 2 out of 5 stars based on public federal clinical and patient-experience measures.

Hospital Profile Acute Care Hospital Voluntary non-profit - Private 469 Beds · urban Updated: 2026-04-15

Carle Foundation Hospital

611 West Park Street, Urbana, IL 61801 · 142 Priced Procedures · 69% Patient Recommendation

CMS Overall Rating 2 / 5 Stars

Good Deal · Below Fair Market

0.94×vs. Fair Market Price

Typical commercial prices here are 6% below the fair benchmark (0.94×) after accounting for local nurse/doctor wages and patient complexity.

68/100 · Caution

68/100Self-Pay Cash Beats Insurance 16% of the Time

File Completeness85

Price Logic88

Peer Alignment64

Clean Billing80

Real Cash Discount6

Regional Benchmark Tier

3-Star CMS clinical quality rating paired with 0.94× fair market pricing.

Behavioral Pricing FingerprintConsistent Department Multiples

Aligned Regional Benchmark Peer

Carle Foundation Hospital prices shoppable and inpatient services (1.0× to 1.0× Medicare, divergence 1.00×) in alignment with regional hospital peers (0.94× Fair BaseRate). Reviewing plan-specific negotiated rates and cash discounts helps lock in the lowest out-of-pocket tier.

#36 of 126 in IL · 27th State Percentile#906 of 3,385 in U.S. · 26th National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Elective shoppable care is priced 6% below peer Fair BaseRate (0.94×)
Self-pay cash beats commercial insurance on 16% of shoppable procedures (25/100 Cash Honesty)
2-Star CMS clinical rating with 69% patient recommendation (61/100 safety score)
IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (30.2% AGB cap)

Watchout

Where You Can Get Burned (Markup Traps)

Outpatient surgery & OR suites carry a 3.3× markup over Medicare rates
Commercial insurance median sits at 0.94× Fair BaseRate (1.0× Medicare), so insured patients should always compare the self-pay cash price before paying.
Specialty infusion drugs (J-codes) average 2.0× Medicare — verify per-unit billing on itemized statements
Consolidated metro market (HHI 6,686) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))

Front-Door ShoppableElective / Imaging

1.0× Medicare

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

Back-Door Captive & ER1.00× Divergence

1.0× Medicare

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

Quantile Tail Spread+6% Upper Tail

Q25 0.83× · Q50 0.94× · Q75 1.00×

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

1.0× MedicareGood

Outpatient Surgery & ORBack-Door Captive

3.3× MedicareElevated

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

3.1× MedicareFair

Back-Door Captive ER VisitsBack-Door Captive

2.2× MedicareFair

Inpatient Lab & PathologyBack-Door Captive

2.2× MedicareFair

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

2.0× MedicareGood

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

16% Cash Edge · 25/100Watchout

CMS Clinical Safety & Star ValueIntegrity & Outcomes

2 CMS · 61/100Elevated

Procedure Prices at Carle Foundation Hospital

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 142 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`	—	$28,465	$30,775	0.9×
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	—	$17,641	$19,087	0.9×
Hip or knee replacement (inpatient stay) MS-DRG Code: `470`	—	$17,527	$19,432	0.9×
Heart stent placement (inpatient stay) MS-DRG Code: `322`	—	$16,132	$17,936	0.9×
Total hip replacement CPT Code: `27130`	—	$13,758	$13,413	1.0×
Total knee replacement CPT Code: `27447`	—	$13,758	$13,523	1.0×
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	—	$7,867	$8,223	1.0×
Gallbladder removal (laparoscopic) CPT Code: `47562`	—	$6,479	$6,109	1.1×
Breast lump removal CPT Code: `19120`	—	$4,196	$3,875	unverified
Inguinal hernia repair CPT Code: `49505`	—	$3,837	$3,629	unverified
Knee arthroscopy with meniscus repair CPT Code: `29881`	—	$3,506	$3,372	1.0×
Bunion correction surgery CPT Code: `28296`	—	$3,506	$3,446	1.0×
C-section delivery (full package) CPT Code: `59510`	—	$2,660	$2,975	0.9×
Cataract surgery with lens implant CPT Code: `66984`	—	$2,473	$2,540	1.0×
Vaginal delivery (full package) CPT Code: `59400`	—	$2,358	$2,680	0.9×
Trauma team activation HCPCS Code: `G0390`	$6,752	$1,428	$1,453	1.0×
Colonoscopy with biopsy CPT Code: `45380`	$4,431	$1,282	$1,256	unverified
Colonoscopy (diagnostic) CPT Code: `45378`	$3,371	$997	$981	1.0×
Upper endoscopy with biopsy CPT Code: `43239`	$3,045	$972	$987	1.0×
Sleep study (overnight, in lab) CPT Code: `95810`	$6,563	$920	$1,021	0.9×
Injection procedure for pain management HCPCS Code: `G0260`	$2,347	$756	$855	0.9×
Echocardiogram (heart ultrasound) CPT Code: `93306`	$4,836	$586	$583	1.0×
Blood transfusion CPT Code: `36430`	$1,160	$473	$498	0.9×
Residential mental health treatment HCPCS Code: `H2036`	—	$406	$406	1.0×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$7,518	$374	$448	0.8×
MRI, brain (with and without contrast) CPT Code: `70553`	$7,928	$374	$511	0.7×
Psychological testing by technician CPT Code: `96138`	$368	$368	$395	unverified
Neurobehavioral status check CPT Code: `96116`	$966	$231	$231	1.0×
Ultrasound, leg veins (duplex) CPT Code: `93970`	$2,100	$256	$272	0.9×
Rabies immune globulin HCPCS Code: `90375`	$2,999	$280	$322	0.9×
Breathing treatment (nebulizer) CPT Code: `94640`	$273	$235	$201	1.2×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$6,195	$256	$303	0.8×
MRI, lower back (no contrast) CPT Code: `72148`	$5,292	$256	$338	0.8×
MRI, brain (no contrast) CPT Code: `70551`	$4,841	$256	$343	0.7×
Behavioral health residential care HCPCS Code: `H0011`	—	$256	$364	0.7×
MRI, knee or other leg joint CPT Code: `73721`	$5,576	$256	$369	0.7×
Psychotherapy session (45 minutes) CPT Code: `90834`	$599	$190	$166	1.1×
Psychotherapy session (60 minutes) CPT Code: `90837`	$599	$190	$181	1.0×
Psychiatric evaluation (first visit) CPT Code: `90791`	$599	$190	$185	1.0×
CT scan, head (with contrast) CPT Code: `70460`	$3,560	$188	$242	0.8×
CT scan, head (with and without contrast) CPT Code: `70470`	$4,095	$188	$258	0.7×
Family therapy session CPT Code: `90847`	$599	$190	$173	unverified
Diagnostic mammogram (both breasts) CPT Code: `77066`	$924	$148	$148	1.0×
New patient office visit (30-44 min) CPT Code: `99203`	$215	$115	$110	1.0×
Hepatitis B immune globulin HCPCS Code: `90371`	$693	$138	$151	0.9×
X-ray, pelvis CPT Code: `72170`	$840	$112	$110	1.0×
Screening mammogram (both breasts) CPT Code: `77067`	$924	$119	$123	1.0×
X-ray, chest (single view) CPT Code: `71045`	$554	$93	$92	1.0×
X-ray, foot CPT Code: `73630`	$693	$93	$92	1.0×
X-ray, neck (cervical spine) CPT Code: `72040`	$830	$93	$93	1.0×
X-ray, hip CPT Code: `73502`	$914	$93	$93	1.0×
X-ray, ankle CPT Code: `73610`	$693	$93	$93	1.0×
Ultrasound, abdomen (limited) CPT Code: `76705`	$1,470	$112	$126	0.9×
Ultrasound, pelvis CPT Code: `76856`	$1,397	$112	$130	0.9×
Ultrasound, thyroid and neck CPT Code: `76536`	$1,397	$112	$132	0.8×
Ultrasound, abdomen (complete) CPT Code: `76700`	$2,085	$112	$134	0.8×
CT scan, head (no contrast) CPT Code: `70450`	$3,812	$112	$160	0.7×
CT scan, pelvis CPT Code: `72192`	$4,148	$112	$163	0.7×
CT scan, sinuses CPT Code: `70486`	$3,581	$112	$166	0.7×
CT scan, chest (no contrast) CPT Code: `71250`	$3,906	$112	$167	0.7×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$3,738	$112	$168	0.7×
CT scan, neck (cervical spine) CPT Code: `72125`	$4,421	$112	$169	0.7×
Behavioral health counseling (per session) HCPCS Code: `H0008`	—	$112	$257	0.4×
Behavioral health day treatment HCPCS Code: `H0010`	—	$121	$343	0.4×
Psychological testing evaluation CPT Code: `96136`	$662	$143	$128	unverified
Care planning with family CPT Code: `90887`	$352	$87	$107	0.8×
X-ray, chest (two views) CPT Code: `71046`	$609	$93	$93	unverified
X-ray, lower back CPT Code: `72110`	$1,113	$112	$112	unverified
X-ray, shoulder CPT Code: `73030`	$683	$93	$92	unverified
X-ray, hand CPT Code: `73130`	$693	$93	$93	unverified
Group therapy session CPT Code: `90853`	$357	$109	$100	unverified
Office visit, established patient (30-39 min) CPT Code: `99214`	$725	$132	$123	unverified
Office visit, established patient (20-29 min) CPT Code: `99213`	$215	$93	$87	unverified
Typhoid vaccine HCPCS Code: `90675`	$625	$320	$347	0.9×
Varicella (chickenpox) vaccine HCPCS Code: `90716`	$276	$180	$203	0.9×
Pneumococcal vaccine HCPCS Code: `90732`	$358	$133	$140	0.9×
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	$141	$99	$111	0.9×
Diagnostic procedure preparation HCPCS Code: `G0279`	$851	$39	$35	1.1×
Flu vaccine injection HCPCS Code: `G0008`	$168	$50	$48	1.0×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$462	$63	$64	1.0×
Speech therapy (language evaluation) CPT Code: `92507`	$630	$74	$86	0.9×
Colorectal cancer screening (alternative) HCPCS Code: `G0145`	$488	$26	$27	1.0×
Prostate cancer screening (blood test) HCPCS Code: `G0103`	$368	$19	$20	0.9×
Prosthetic fitting and training CPT Code: `97761`	$205	$39	$45	0.9×
Orthotic fitting and training CPT Code: `97760`	$215	$44	$51	0.9×
Hospital observation (per hour) HCPCS Code: `G0378`	—	$61	$86	0.7×
Residential substance abuse treatment HCPCS Code: `H2035`	—	$60	$88	0.7×
Review of medical records for care CPT Code: `90889`	$336	$66	$114	0.6×
Drug screening test HCPCS Code: `G0480`	$61	$61	$116	0.5×
Extended office visit (prolonged) HCPCS Code: `G2212`	$221	$34	$33	1.0×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$72	$40	$56	0.7×
Blood antibody screen CPT Code: `86850`	$183	$56	$46	unverified
Blood test, comprehensive metabolic panel CPT Code: `80053`	$313	$11	$11	1.0×
Blood test, potassium CPT Code: `84132`	$168	$5	$5	1.0×
Blood test, sodium CPT Code: `84295`	$163	$5	$5	1.0×
Blood test, vitamin D CPT Code: `82306`	$247	$30	$31	1.0×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$168	$3	$3	1.0×
Blood test, calcium CPT Code: `82310`	$64	$5	$5	1.0×
Blood test, creatinine (kidney) CPT Code: `82565`	$194	$5	$5	1.0×
Blood test, ferritin (iron stores) CPT Code: `82728`	$213	$14	$14	1.0×
Blood test, glucose (blood sugar) CPT Code: `82947`	$189	$4	$4	1.0×
Blood test, average blood sugar (A1c) CPT Code: `83036`	$41	$10	$10	1.0×
Blood test, lipase CPT Code: `83690`	$143	$7	$7	1.0×
Blood test, magnesium CPT Code: `83735`	$92	$7	$7	1.0×
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$147	$4	$4	1.0×
Blood test, complete blood count (CBC) CPT Code: `85025`	$125	$8	$8	1.0×
Blood test, clotting time (PTT) CPT Code: `85730`	$158	$6	$6	1.0×
Culture, bacterial CPT Code: `87070`	$323	$9	$9	1.0×
Blood test, PSA (prostate screen) CPT Code: `84153`	$78	$18	$19	0.9×
Blood test, thyroid (TSH) CPT Code: `84443`	$153	$17	$18	0.9×
Blood test, vitamin B12 CPT Code: `82607`	$326	$15	$16	0.9×
Hepatitis C antibody test CPT Code: `86803`	$300	$14	$15	0.9×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$389	$13	$14	0.9×
Flu vaccine (high dose) HCPCS Code: `90656`	$30	$23	$25	0.9×
Culture, blood CPT Code: `87040`	$336	$10	$11	0.9×
Blood test, basic metabolic panel CPT Code: `80048`	$100	$8	$9	0.9×
Blood test, liver function panel CPT Code: `80076`	$320	$8	$9	0.9×
Blood test, amylase CPT Code: `82150`	$36	$6	$7	0.9×
Electrical stimulation therapy HCPCS Code: `G0283`	$166	$12	$14	0.9×
Speech therapy (group session) CPT Code: `92508`	$528	$23	$27	0.9×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$226	$34	$40	0.8×
Physical therapy (gait training) CPT Code: `97116`	$168	$28	$33	0.8×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$184	$32	$38	0.8×
Physical therapy (functional capacity test) CPT Code: `97750`	$213	$32	$38	0.8×
Occupational therapy (self-care training) CPT Code: `97535`	$189	$31	$38	0.8×
Blood test, clotting time (PT/INR) CPT Code: `85610`	$152	$4	$5	0.8×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$176	$28	$35	0.8×
DTaP vaccine (diphtheria, tetanus, pertussis) HCPCS Code: `90700`	$44	$31	$39	0.8×
Physical therapy (manual therapy) CPT Code: `97140`	$205	$27	$34	0.8×
Behavioral health living support HCPCS Code: `H2019`	—	$14	$34	0.4×
Behavioral health day program HCPCS Code: `H2012`	—	$39	$100	0.4×
Behavioral health assessment HCPCS Code: `H0001`	—	$36	$157	0.2×
Behavioral health outpatient services HCPCS Code: `H2015`	—	$10	$16	0.6×
Electrocardiogram (ECG/EKG) CPT Code: `93000`	—	$15	$25	0.6×
Mental health services (assessment) HCPCS Code: `H0031`	—	$29	$140	0.2×
Mental health services (therapy) HCPCS Code: `H0032`	—	$12	$65	0.2×
Hepatitis B vaccine HCPCS Code: `90744`	$43	$33	$37	unverified
Community mental health services HCPCS Code: `H0038`	—	$2	$16	0.1×
Behavioral health counseling (group) HCPCS Code: `H0009`	—	$26	$269	0.1×
Pneumonia vaccine injection HCPCS Code: `G0009`	$163	$50	$49	unverified
Colorectal cancer screening HCPCS Code: `G0010`	$158	$50	$49	unverified
Blood test, hemoglobin CPT Code: `85018`	$67	$2	$3	0.7×

Showing top 25 high-impact procedures of 142 total

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 30.2%

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

CMS CCN: 140091

CPT 451

Select Procedure to Audit:

Fair BaseRate™ $30,775

Medicare Rate $23,504

Self-Pay Cash Request Quote

Insurer Median $28,465

1. Amount on Your Bill or Quote ($) Pre-filled with Carle Foundation 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: $20,659 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $20,659

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (30.2% of gross = $20,659).

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

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask Carle Foundation 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 +$37,541 Above Fair BaseRate

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

Your bill ($68,316) is $37,541 above the denoised Fair BaseRate ($30,775) and 2.9× 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)

EIN: 371119538

Filing Period: 198210

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 (30.2% 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.

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 Composite61/100

Would Recommend69%

Rated 9 or 10 (HCAHPS)71%

Median ER Wait214 min

Left ER Before Seen2%

30-Day Mortality vs U.S.same

Unplanned Readmissionworse

Hip/Knee Complication Rate5%

Healthcare-Associated Infections (CDC NHSN / CMS HAI)

1.00 SIR = National Predicted Baseline (Lower Is Safer)

Central-Line Bloodstream Infectionbetter

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

2026-03-25·warning_notice
Warning Notice
Recorded
2023-11-29·administrative_or_closure
Closure Notice
Recorded
2023-10-13·cap_corrective_action
CAP Request
Recorded
2023-04-18·warning_notice
Warning Notice
Recorded

Source: CMS Hospital Care Compare (415 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 Quality & Price Benchmark

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

Price Index: 1.12× regional baseline

Quality: 54/100 CMS composite

Median Household Income$63,091U.S. Census ACS

Local Uninsured Share5.0%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 68/100 · Caution CMS CCN 140091 EIN 371119538

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

Download Official Hospital MRF ↗ Verify on CMS Medicare.gov (CCN 140091) ↗ Verify IRS Form 990 (EIN 371119538) ↗ CMS HCRIS Cost Reports ↗

Published MRF File371119538_the-carle-foundation-hospital_standardcharges.csv

Publication / Vintage2026-04-15 · 664.87 MB

Validated Rate Rows7,340 (CMS v3.0.0)

File Integrity Digeste7c6381f7c8ce2b634d5…

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.

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