CMS Price Transparency Data

Blood test, PSA (prostate screen)

Facility: Decatur Memorial Hospital

Billing Code: 84153 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84153
Insurance Median: $151
Cash Discount Price: $326
vs. Medicare Baseline: 8.21x Medicare

The contracted insurance negotiated median rate for a Blood test, PSA (prostate screen) at Decatur Memorial Hospital is $151. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $326. Compared to the federal Medicare reimbursement reference rate of $18.39, this hospital’s rate is 8.21x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$326

Average discount available for prompt cash payment at this facility.

Insurance Median

$151

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$18.39

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $18.39 (100%)

Cash / Self-Pay: $326 (1773%)

Insurance Median: $151 (821%)

Cash: $326 (1773% of Medicare)

Ins. Median: $151 (821% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $18.39 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 821% of the Medicare baseline (a markup of 721%). 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	$12	65%
Blue Cross Blue Shield	$17 - $326	92%
Aetna	$18 - $219	98%
Coventry	$18 - $165	98%
Health Alliance	$18 - $217	98%
Humana	$18 - $212	98%
Medicare (plans)	$18	98%
Tricare	$18	98%
UnitedHealthcare	$18 - $326	98%
Veterans Administration	$18	98%
Wellcare	$18	98%
Caterpillar	$23	125%
Plain Church Medical Group	$25 - $147	136%
Illinois Workers Compensation	$82 - $100	446%
Hfn	$94 - $244	511%
Commercial Workers Compensation	$95	517%
Mennonite Churches	$114	620%
Health Alliance Mh Employee Plan	$150	816%
Cigna	$152	827%
6 Degrees Health	$196	1066%
Hopetrust	$196	1066%
Hst	$196	1066%
Phcs Savility	$212	1153%
Phcs Multiplan Ppo	$222	1207%
Healthlink	$224	1218%
Corvel	$235	1278%
Consociate	$241	1310%
Liability	$326	1773%

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 $326.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 84153.

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 84153.
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.