CMS Price Transparency Data

CT scan, sinuses

Facility: Decatur Memorial Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $973
Cash Discount Price: $3,564
vs. Medicare Baseline: 9.11x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Decatur Memorial Hospital is $973. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,564. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 9.11x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$3,564

Average discount available for prompt cash payment at this facility.

Insurance Median

$973

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: $3,564 (3337%)

Insurance Median: $973 (911%)

Cash: $3,564 (3337% of Medicare)

Ins. Median: $973 (911% 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 911% of the Medicare baseline (a markup of 811%). 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 - $3,564	96%
Aetna	$110 - $2,391	103%
Coventry	$110 - $1,807	103%
Health Alliance	$110 - $2,370	103%
Humana	$110 - $988	103%
Medicare (plans)	$110 - $119	103%
UnitedHealthcare	$110 - $3,564	103%
Veterans Administration	$110 - $119	103%
Wellcare	$110	103%
Tricare	$112 - $121	105%
Medicaid / KanCare	$134 - $137	125%
Plain Church Medical Group	$136 - $1,604	127%
Caterpillar	$252	236%
Hfn	$901 - $2,673	844%
Commercial Workers Compensation	$910	852%
Illinois Workers Compensation	$939 - $958	879%
Cigna	$1,216 - $1,661	1138%
Mennonite Churches	$1,247	1167%
Health Alliance Mh Employee Plan	$1,639	1535%
6 Degrees Health	$2,138	2002%
Hopetrust	$2,138	2002%
Hst	$2,138	2002%
Phcs Savility	$2,317	2169%
Phcs Multiplan Ppo	$2,424	2269%
Healthlink	$2,445	2289%
Corvel	$2,566	2402%
Consociate	$2,637	2469%
Liability	$3,564	3337%

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 $3,564.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70486.

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 70486.
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.