CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Decatur Memorial Hospital

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $14,105
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.10x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Decatur Memorial Hospital is $14,105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 1.10x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$14,105

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$12,807.1

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $12,807.1 (100%)

Insurance Median: $14,105 (110%)

Ins. Median: $14,105 (110% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $12,807.1 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
Corvel	$1,433	11%
Hfn	$8,794 - $11,636	69%
Commercial Workers Compensation	$8,887	69%
Illinois Workers Compensation	$9,355	73%
Health Alliance	$10,578 - $18,628	83%
Phcs Savility	$10,774	84%
Plain Church Medical Group	$11,848	93%
Humana	$12,107 - $13,204	95%
Blue Cross Blue Shield	$13,682 - $14,105	107%
Consociate	$13,709	107%
Coventry	$14,105 - $15,638	110%
UnitedHealthcare	$14,105 - $38,134	110%
Wellcare	$14,105	110%
Tricare	$14,358	112%
Aetna	$14,477 - $24,329	113%
Medicare (plans)	$14,477	113%
Veterans Administration	$14,477	113%
Healthlink	$14,881	116%
Caterpillar	$14,978	117%
Cigna	$17,069	133%

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 $X.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 322.

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 MS-DRG code 322.
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.