CMS Price Transparency Data

CT scan, head (with and without contrast)

Facility: Decatur Memorial Hospital

Billing Code: 70470 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70470
Insurance Median: $1,239
Cash Discount Price: $4,627
vs. Medicare Baseline: 6.91x Medicare

The contracted insurance negotiated median rate for a CT scan, head (with and without contrast) at Decatur Memorial Hospital is $1,239. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,627. Compared to the federal Medicare reimbursement reference rate of $179.2, this hospital’s rate is 6.91x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$4,627

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,239

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$179.2

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $179.2 (100%)

Cash / Self-Pay: $4,627 (2582%)

Insurance Median: $1,239 (691%)

Cash: $4,627 (2582% of Medicare)

Ins. Median: $1,239 (691% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $179.2 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 691% of the Medicare baseline (a markup of 591%). 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	$161 - $3,105	90%
Blue Cross Blue Shield	$161 - $4,627	90%
Coventry	$161 - $2,346	90%
Health Alliance	$161 - $3,077	90%
Humana	$161 - $988	90%
Medicare (plans)	$161 - $185	90%
UnitedHealthcare	$161 - $4,627	90%
Veterans Administration	$161 - $185	90%
Tricare	$164 - $188	92%
Wellcare	$185	103%
Plain Church Medical Group	$244 - $2,082	136%
Medicaid / KanCare	$382 - $389	213%
Caterpillar	$423	236%
Hfn	$1,215 - $3,470	678%
Cigna	$1,216 - $2,156	679%
Commercial Workers Compensation	$1,228	685%
Illinois Workers Compensation	$1,250 - $1,293	698%
Mennonite Churches	$1,619	903%
Health Alliance Mh Employee Plan	$2,128	1188%
6 Degrees Health	$2,776	1549%
Hopetrust	$2,776	1549%
Hst	$2,776	1549%
Phcs Savility	$3,008	1679%
Phcs Multiplan Ppo	$3,146	1756%
Healthlink	$3,174	1771%
Corvel	$3,331	1859%
Consociate	$3,424	1911%
Liability	$4,627	2582%

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 $4,627.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70470.

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 70470.
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.