CMS Price Transparency Data

Hepatitis C antibody test

Facility: Decatur Memorial Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $185
Cash Discount Price: $400
vs. Medicare Baseline: 12.96x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Decatur Memorial Hospital is $185. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $400. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 12.96x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$400

Average discount available for prompt cash payment at this facility.

Insurance Median

$185

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$14.27

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14.27 (100%)

Cash / Self-Pay: $400 (2803%)

Insurance Median: $185 (1296%)

Cash: $400 (2803% of Medicare)

Ins. Median: $185 (1296% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $14.27 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 1296% of the Medicare baseline (a markup of 1196%). 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	84%
Blue Cross Blue Shield	$13 - $400	91%
Aetna	$14 - $268	98%
Coventry	$14 - $203	98%
Health Alliance	$14 - $266	98%
Humana	$14 - $260	98%
Medicare (plans)	$14	98%
Tricare	$14	98%
UnitedHealthcare	$14 - $400	98%
Veterans Administration	$14	98%
Wellcare	$14	98%
Caterpillar	$18	126%
Plain Church Medical Group	$19 - $180	133%
Illinois Workers Compensation	$82 - $106	575%
Hfn	$100 - $300	701%
Commercial Workers Compensation	$101	708%
Mennonite Churches	$140	981%
Health Alliance Mh Employee Plan	$184	1289%
Cigna	$186	1303%
6 Degrees Health	$240	1682%
Hopetrust	$240	1682%
Hst	$240	1682%
Phcs Savility	$260	1822%
Phcs Multiplan Ppo	$272	1906%
Healthlink	$274	1920%
Corvel	$288	2018%
Consociate	$296	2074%
Liability	$400	2803%

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 $400.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 86803.

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 86803.
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.