Carle Health Proctor Hospital: charges and Medicare payments

Carle Health Proctor Hospital reported 538 Medicare inpatient stays across 19 DRGs in 2024. Across them it charged 5.51 times what it was paid — among the higher ratios in Illinois, number 12 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: 101 stays at an average charge of $54,117, 40% below the national average. It also billed 2,159 outpatient services, charging 7.85 times what Medicare paid.

1Medicare inpatient stays 538
2Charge ÷ paid, inpatient 5.51×
3Rank in IL (highest ratio = 1) 12 of 106
4CMS price-transparency actions 0

Average charge per stay at Carle Health Proctor Hospital, its 10 most frequent DRGs, bars to scale. Source: CMS DY2024.

Inpatient stays

For the 19 DRGs that can be compared with the national average, Carle Health Proctor Hospital charged more than the national average in 4 (21%). 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	101	$54,117	-40%	$12,827
481 Hip and Femur Procedures except Major Joint with CC	69	$82,871	-18%	$13,867
291 Heart Failure and Shock with MCC	60	$44,493	-21%	$8,728
470 Major Hip and Knee Joint Replacement or Reattachment of...	30	$95,430	+2%	$13,162
480 Hip and Femur Procedures except Major Joint with MCC	30	$118,047	-15%	$23,810
177 Respiratory Infections and Inflammations with MCC	24	$55,036	-22%	$11,036
522 Hip Replacement with Principal Diagnosis of Hip Fracture...	24	$83,720	-18%	$14,407
872 Septicemia or Severe Sepsis without MV >96 Hours without MCC	24	$37,210	-24%	$6,879
189 Pulmonary Edema and Respiratory Failure	20	$66,347	+15%	$10,789
193 Simple Pneumonia and Pleurisy with MCC	19	$62,399	+4%	$9,174
483 Major Joint or Limb Reattachment Procedures of Upper...	19	$136,855	+8%	$17,308
493 Lower Extremity and Humerus Procedures except Hip, Foot and...	18	$95,185	-20%	$16,522
683 Renal Failure with CC	18	$29,996	-26%	$5,894
467 Revision of Hip or Knee Replacement with CC	17	$134,331	-15%	$24,027
521 Hip Replacement with Principal Diagnosis of Hip Fracture...	15	$102,722	-24%	$18,580
682 Renal Failure with MCC	15	$54,663	-17%	$10,183
897 Alcohol, Drug Abuse or Dependence without Rehabilitation...	13	$24,845	-33%	$5,586
640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	11	$50,748	-16%	$8,918
812 Red Blood Cell Disorders without MCC	11	$37,035	-17%	$5,907

Outpatient services

Service (APC)	Services	Avg charge	Medicare allowed
Level 5 Musculoskeletal Procedures	662	$66,182	$12,022
Level 1 Intraocular Procedures	566	$21,354	$2,148
Level 1 Nerve Procedures	173	$18,775	$1,760
Level 3 Musculoskeletal Procedures	127	$32,061	$2,954
Level 4 Musculoskeletal Procedures	126	$51,594	$6,528
Level 2 Intraocular Procedures	105	$33,908	$3,729
Level 6 Musculoskeletal Procedures	104	$98,343	$17,185
Comprehensive Observation Services	63	$22,826	$2,530
Level 3 Extraocular, Repair, and Plastic Eye Procedures	42	$25,034	$2,119
Level 2 Musculoskeletal Procedures	36	$20,229	$1,453
Level 3 Intraocular Procedures	36	$33,541	$4,723
Level 2 Excision/ Biopsy/ Incision and Drainage	28	$17,843	$1,456
Level 5 Gynecologic Procedures	24	$43,150	$4,139
Level 3 Vascular Procedures	22	$17,884	$2,946
Level 3 Excision/ Biopsy/ Incision and Drainage	16	$28,993	$2,462
Level 3 Urology and Related Services	16	$15,988	$1,789
Level 5 Urology and Related Services	13	$36,051	$4,782

Against the Illinois average

For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Carle Health Proctor Hospital charged $54,117 on average, 27% less than the Illinois average of $73,987, and was paid $12,827 against a state average of $17,651. For Hip and Femur Procedures except Major Joint with CC (DRG 481), Carle Health Proctor Hospital charged $82,871 on average, 7% less than the Illinois average of $88,742, and was paid $13,867 against a state average of $17,886. For Heart Failure and Shock with MCC (DRG 291), Carle Health Proctor Hospital charged $44,493 on average, 4% less than the Illinois average of $46,293, and was paid $8,728 against a state average of $11,813. For Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC (DRG 470), Carle Health Proctor Hospital charged $95,430 on average, 19% more than the Illinois average of $79,993, and was paid $13,162 against a state average of $16,670. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $66,182 was 1% below the state average of $67,146. For Level 1 Intraocular Procedures (outpatient APC 5491), its average charge of $21,354 was 43% above the state average of $14,917. For Level 1 Nerve Procedures (outpatient APC 5431), its average charge of $18,775 was 46% above the state average of $12,903. For Level 3 Musculoskeletal Procedures (outpatient APC 5113), its average charge of $32,061 was 36% above the state average of $23,572.

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.