CMS Price Transparency Data

X-ray, ankle

Facility: Decatur Memorial Hospital

Billing Code: 73610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73610
Insurance Median: $206
Cash Discount Price: $829
vs. Medicare Baseline: 2.32x Medicare

The contracted insurance negotiated median rate for a X-ray, ankle at Decatur Memorial Hospital is $206. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $829. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 2.32x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$829

Average discount available for prompt cash payment at this facility.

Insurance Median

$206

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$88.91

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $88.91 (100%)

Cash / Self-Pay: $829 (932%)

Insurance Median: $206 (232%)

Cash: $829 (932% of Medicare)

Ins. Median: $206 (232% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $88.91 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 232% of the Medicare baseline (a markup of 132%). 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	$34 - $556	38%
Blue Cross Blue Shield	$34 - $829	38%
Coventry	$34 - $420	38%
Health Alliance	$34 - $551	38%
Humana	$34 - $539	38%
Medicare (plans)	$34 - $92	38%
UnitedHealthcare	$34 - $829	38%
Veterans Administration	$34 - $92	38%
Tricare	$35 - $93	39%
Medicaid / KanCare	$70 - $72	79%
Plain Church Medical Group	$75 - $373	84%
Wellcare	$92	103%
Illinois Workers Compensation	$102 - $189	115%
Hfn	$178 - $622	200%
Commercial Workers Compensation	$180	202%
Caterpillar	$210	236%
Mennonite Churches	$290	326%
Health Alliance Mh Employee Plan	$381	429%
Cigna	$386	434%
6 Degrees Health	$497	559%
Hopetrust	$497	559%
Hst	$497	559%
Phcs Savility	$539	606%
Phcs Multiplan Ppo	$564	634%
Healthlink	$569	640%
Corvel	$597	671%
Consociate	$613	689%
Liability	$829	932%

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 $829.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 73610.

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 73610.
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.