CMS Price Transparency Data

CT scan, pelvis

Facility: Decatur Memorial Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $1,376
Cash Discount Price: $2,831
vs. Medicare Baseline: 12.88x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Decatur Memorial Hospital is $1,376. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,831. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 12.88x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$2,831

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,376

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $2,831 (2651%)

Insurance Median: $1,376 (1288%)

Cash: $2,831 (2651% of Medicare)

Ins. Median: $1,376 (1288% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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 1288% of the Medicare baseline (a markup of 1188%). 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	$103 - $2,971	96%
Aetna	$110 - $1,994	103%
Coventry	$110 - $1,506	103%
Health Alliance	$110 - $1,976	103%
Humana	$110 - $988	103%
Medicare (plans)	$110 - $124	103%
UnitedHealthcare	$110 - $2,971	103%
Veterans Administration	$110 - $124	103%
Wellcare	$110	103%
Tricare	$112 - $126	105%
Medicaid / KanCare	$134 - $137	125%
Plain Church Medical Group	$136 - $1,337	127%
Caterpillar	$252	236%
Hfn	$887 - $2,228	830%
Commercial Workers Compensation	$896	839%
Mennonite Churches	$942 - $1,040	882%
Illinois Workers Compensation	$943 - $990	883%
Cigna	$1,216 - $1,384	1138%
Health Alliance Mh Employee Plan	$1,237 - $1,367	1158%
6 Degrees Health	$1,614 - $1,783	1511%
Hopetrust	$1,614 - $1,783	1511%
Hst	$1,614 - $1,783	1511%
Phcs Savility	$1,748 - $1,931	1637%
Phcs Multiplan Ppo	$1,829 - $2,020	1712%
Healthlink	$1,845 - $2,038	1727%
Corvel	$1,937 - $2,139	1814%
Consociate	$1,991 - $2,199	1864%
Liability	$2,690 - $2,971	2518%

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 $2,831.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72192.

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 72192.
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.