CMS Price Transparency Data

Blood antibody screen

Facility: Decatur Memorial Hospital

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $88
Cash Discount Price: $170
vs. Medicare Baseline: 1.65x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at Decatur Memorial Hospital is $88. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $170. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 1.65x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$170

Average discount available for prompt cash payment at this facility.

Insurance Median

$88

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$53.24

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $53.24 (100%)

Cash / Self-Pay: $170 (319%)

Insurance Median: $88 (165%)

Cash: $170 (319% of Medicare)

Ins. Median: $88 (165% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $53.24 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.

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
Medicaid / KanCare	$5	9%
Aetna	$10 - $130	19%
Blue Cross Blue Shield	$10 - $194	19%
Coventry	$10 - $98	19%
Health Alliance	$10 - $129	19%
Humana	$10 - $126	19%
Medicare (plans)	$10 - $55	19%
Tricare	$10 - $56	19%
UnitedHealthcare	$10 - $194	19%
Veterans Administration	$10 - $55	19%
Illinois Workers Compensation	$30 - $65	56%
Mennonite Churches	$51 - $68	96%
Wellcare	$55	103%
Commercial Workers Compensation	$61	115%
Hfn	$61 - $146	115%
Plain Church Medical Group	$62 - $87	116%
Health Alliance Mh Employee Plan	$67 - $89	126%
Cigna	$68 - $90	128%
6 Degrees Health	$88 - $116	165%
Hopetrust	$88 - $116	165%
Hst	$88 - $116	165%
Phcs Savility	$95 - $126	178%
Phcs Multiplan Ppo	$99 - $132	186%
Healthlink	$100 - $133	188%
Corvel	$105 - $140	197%
Consociate	$108 - $144	203%
Caterpillar	$126	237%
Liability	$146 - $194	274%

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 $170.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 86850.

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 86850.
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.