CMS Price Transparency Data

Blood test, creatinine (kidney)

Facility: Decatur Memorial Hospital

Billing Code: 82565 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 82565
Insurance Median: $29
Cash Discount Price: $51
vs. Medicare Baseline: 5.66x Medicare

The contracted insurance negotiated median rate for a Blood test, creatinine (kidney) at Decatur Memorial Hospital is $29. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $51. Compared to the federal Medicare reimbursement reference rate of $5.12, this hospital’s rate is 5.66x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$51

Average discount available for prompt cash payment at this facility.

Insurance Median

$29

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$5.12

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $5.12 (100%)

Cash / Self-Pay: $51 (996%)

Insurance Median: $29 (566%)

Cash: $51 (996% of Medicare)

Ins. Median: $29 (566% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $5.12 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 566% of the Medicare baseline (a markup of 466%). 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	$5 - $38	98%
Blue Cross Blue Shield	$5 - $57	98%
Coventry	$5 - $29	98%
Health Alliance	$5 - $38	98%
Humana	$5 - $37	98%
Medicare (plans)	$5	98%
Tricare	$5	98%
UnitedHealthcare	$5 - $57	98%
Veterans Administration	$5	98%
Wellcare	$5	98%
Caterpillar	$6	117%
Medicaid / KanCare	$6	117%
Plain Church Medical Group	$7 - $26	137%
Mennonite Churches	$15 - $20	293%
Cigna	$20 - $27	391%
Health Alliance Mh Employee Plan	$20 - $26	391%
6 Degrees Health	$26 - $34	508%
Hopetrust	$26 - $34	508%
Hst	$26 - $34	508%
Illinois Workers Compensation	$26 - $49	508%
Phcs Savility	$29 - $37	566%
Healthlink	$30 - $39	586%
Phcs Multiplan Ppo	$30 - $39	586%
Corvel	$32 - $41	625%
Consociate	$33 - $42	645%
Hfn	$33 - $46	645%
Liability	$44 - $57	859%
Commercial Workers Compensation	$46	898%

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 $51.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 82565.

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 82565.
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.