CMS Price Transparency Data

Blood test, clotting time (PTT)

Facility: Decatur Memorial Hospital

Billing Code: 85730 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85730
Insurance Median: $53
Cash Discount Price: $142
vs. Medicare Baseline: 8.82x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PTT) at Decatur Memorial Hospital is $53. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $142. Compared to the federal Medicare reimbursement reference rate of $6.01, this hospital’s rate is 8.82x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$142

Average discount available for prompt cash payment at this facility.

Insurance Median

$53

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$6.01

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $6.01 (100%)

Cash / Self-Pay: $142 (2363%)

Insurance Median: $53 (882%)

Cash: $142 (2363% of Medicare)

Ins. Median: $53 (882% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $6.01 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 882% of the Medicare baseline (a markup of 782%). 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
Blue Cross Blue Shield	$5 - $205	83%
Medicaid / KanCare	$5	83%
Aetna	$6 - $138	100%
Coventry	$6 - $104	100%
Health Alliance	$6 - $136	100%
Humana	$6 - $133	100%
Medicare (plans)	$6	100%
Tricare	$6	100%
UnitedHealthcare	$6 - $205	100%
Veterans Administration	$6	100%
Wellcare	$6	100%
Caterpillar	$8	133%
Plain Church Medical Group	$8 - $92	133%
Mennonite Churches	$27 - $72	449%
Illinois Workers Compensation	$33 - $53	549%
Cigna	$36 - $96	599%
Health Alliance Mh Employee Plan	$36 - $94	599%
6 Degrees Health	$47 - $123	782%
Hopetrust	$47 - $123	782%
Hst	$47 - $123	782%
Commercial Workers Compensation	$50	832%
Hfn	$50 - $154	832%
Phcs Savility	$51 - $133	849%
Phcs Multiplan Ppo	$53 - $139	882%
Healthlink	$54 - $141	899%
Corvel	$56 - $148	932%
Consociate	$58 - $152	965%
Liability	$78 - $205	1298%

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 $142.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 85730.

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 85730.
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.