CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Decatur Memorial Hospital

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $124
Cash Discount Price: $265
vs. Medicare Baseline: 11.74x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Decatur Memorial Hospital is $124. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $265. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 11.74x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$265

Average discount available for prompt cash payment at this facility.

Insurance Median

$124

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$10.56

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $10.56 (100%)

Cash / Self-Pay: $265 (2509%)

Insurance Median: $124 (1174%)

Cash: $265 (2509% of Medicare)

Ins. Median: $124 (1174% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $10.56 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 1174% of the Medicare baseline (a markup of 1074%). 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
Medicaid / KanCare	$9	85%
Aetna	$10 - $178	95%
Blue Cross Blue Shield	$10 - $265	95%
Coventry	$10 - $134	95%
Health Alliance	$10 - $176	95%
Humana	$10 - $172	95%
Medicare (plans)	$10	95%
UnitedHealthcare	$10 - $265	95%
Veterans Administration	$10	95%
Wellcare	$10	95%
Tricare	$11	104%
Caterpillar	$13	123%
Plain Church Medical Group	$14 - $119	133%
Illinois Workers Compensation	$59 - $131	559%
Mennonite Churches	$93	881%
Health Alliance Mh Employee Plan	$122	1155%
Cigna	$123	1165%
Hfn	$123 - $199	1165%
Commercial Workers Compensation	$124	1174%
6 Degrees Health	$159	1506%
Hopetrust	$159	1506%
Hst	$159	1506%
Phcs Savility	$172	1629%
Phcs Multiplan Ppo	$180	1705%
Healthlink	$182	1723%
Corvel	$191	1809%
Consociate	$196	1856%
Liability	$265	2509%

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 $265.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 80053.

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 80053.
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.