CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Decatur Memorial Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $37
Cash Discount Price: $63
vs. Medicare Baseline: 8.62x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Decatur Memorial Hospital is $37. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $63. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 8.62x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$63

Average discount available for prompt cash payment at this facility.

Insurance Median

$37

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$4.29

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $4.29 (100%)

Cash / Self-Pay: $63 (1469%)

Insurance Median: $37 (862%)

Cash: $63 (1469% of Medicare)

Ins. Median: $37 (862% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $4.29 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 862% of the Medicare baseline (a markup of 762%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$4 - $44	93%
Blue Cross Blue Shield	$4 - $65	93%
Coventry	$4 - $33	93%
Health Alliance	$4 - $43	93%
Humana	$4 - $42	93%
Medicare (plans)	$4	93%
Tricare	$4	93%
UnitedHealthcare	$4 - $65	93%
Veterans Administration	$4	93%
Wellcare	$4	93%
Caterpillar	$5	117%
Medicaid / KanCare	$5	117%
Plain Church Medical Group	$5 - $29	117%
Mennonite Churches	$21 - $23	490%
Illinois Workers Compensation	$26 - $50	606%
Cigna	$28 - $30	653%
Health Alliance Mh Employee Plan	$28 - $30	653%
6 Degrees Health	$36 - $39	839%
Hopetrust	$36 - $39	839%
Hst	$36 - $39	839%
Phcs Savility	$39 - $42	909%
Healthlink	$41 - $45	956%
Phcs Multiplan Ppo	$41 - $44	956%
Corvel	$43 - $47	1002%
Consociate	$44 - $48	1026%
Hfn	$45 - $49	1049%
Commercial Workers Compensation	$47	1096%
Liability	$60 - $65	1399%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $63.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 85610.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Decatur Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 85610.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.