CMS Price Transparency Data

Culture, blood

Facility: Decatur Memorial Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $211
Cash Discount Price: $455
vs. Medicare Baseline: 20.45x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Decatur Memorial Hospital is $211. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $455. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 20.45x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$455

Average discount available for prompt cash payment at this facility.

Insurance Median

$211

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$10.32

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $10.32 (100%)

Cash / Self-Pay: $455 (4409%)

Insurance Median: $211 (2045%)

Cash: $455 (4409% of Medicare)

Ins. Median: $211 (2045% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $10.32 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 2045% of the Medicare baseline (a markup of 1945%). 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
Blue Cross Blue Shield	$9 - $455	87%
Aetna	$10 - $305	97%
Coventry	$10 - $231	97%
Health Alliance	$10 - $303	97%
Humana	$10 - $296	97%
Medicare (plans)	$10	97%
Tricare	$10	97%
UnitedHealthcare	$10 - $455	97%
Veterans Administration	$10	97%
Wellcare	$10	97%
Medicaid / KanCare	$11	107%
Caterpillar	$13	126%
Plain Church Medical Group	$14 - $205	136%
Illinois Workers Compensation	$58 - $111	562%
Hfn	$105 - $341	1017%
Commercial Workers Compensation	$106	1027%
Mennonite Churches	$159	1541%
Health Alliance Mh Employee Plan	$209	2025%
Cigna	$212	2054%
6 Degrees Health	$273	2645%
Hopetrust	$273	2645%
Hst	$273	2645%
Phcs Savility	$296	2868%
Phcs Multiplan Ppo	$309	2994%
Healthlink	$312	3023%
Corvel	$328	3178%
Consociate	$337	3266%
Liability	$455	4409%

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 $455.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 87040.

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 87040.
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.