CMS Price Transparency Data

X-ray, pelvis

Facility: Decatur Memorial Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $226
Cash Discount Price: $825
vs. Medicare Baseline: 2.12x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Decatur Memorial Hospital is $226. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $825. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.12x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$825

Average discount available for prompt cash payment at this facility.

Insurance Median

$226

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: $825 (772%)

Insurance Median: $226 (212%)

Cash: $825 (772% of Medicare)

Ins. Median: $226 (212% 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 212% of the Medicare baseline (a markup of 112%). 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	$26 - $554	24%
Blue Cross Blue Shield	$26 - $825	24%
Coventry	$26 - $418	24%
Health Alliance	$26 - $549	24%
Humana	$26 - $536	24%
Medicare (plans)	$26 - $110	24%
UnitedHealthcare	$26 - $825	24%
Veterans Administration	$26 - $110	24%
Tricare	$27 - $112	25%
Medicaid / KanCare	$70 - $72	66%
Illinois Workers Compensation	$104 - $154	97%
Wellcare	$110	103%
Plain Church Medical Group	$136 - $371	127%
Hfn	$145 - $619	136%
Commercial Workers Compensation	$147	138%
Caterpillar	$252	236%
Mennonite Churches	$289	271%
Health Alliance Mh Employee Plan	$380	356%
Cigna	$384	360%
6 Degrees Health	$495	463%
Hopetrust	$495	463%
Hst	$495	463%
Phcs Savility	$536	502%
Phcs Multiplan Ppo	$561	525%
Healthlink	$566	530%
Corvel	$594	556%
Consociate	$610	571%
Liability	$825	772%

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 $825.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72170.

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 72170.
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.