CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Decatur Memorial Hospital

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$16,711

about 1.2× the $14,044 Medicare rate · typically $15,216–$19,362

modeled estimate · not a bill or quote

What this hospital charges insurers

$15,380

About the fair price

about $1,331 under the fair price · 1.1× Medicare

Medicare pays $14,044 Fair price $16,711 This hospital $15,380

How we calculate the fair BaseRate →

How this hospital compares to other IL hospitals

Highest price of the 9 IL hospitals we have prices for — worth calling around.

Cheapest $12,226 Priciest $15,380

Black dot = this hospital, among the 9 IL hospitals with a price for this procedure. Full list below.

A fair price for a Hip or knee replacement (inpatient stay) is about $16,711 (about 1.2× the $14,044 Medicare rate). Decatur Memorial Hospital charges insurers about $15,380 — about the fair price. Located in Decatur, IL.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$15,380 - $41,722	110%
Blue Cross Blue Shieldmajor	$14,918 - $15,380	106%
Aetnamajor	$15,380 - $26,619	110%
Cignamajor	$18,676	133%
Humanamajor	$13,246 - $14,443	94%
HealthLink	$16,282	116%
WellCare	$15,380	110%
+ 5 smaller / regional plans	$11,573 - $20,381

Government programs also on file: Medicare, Military & VA.

Excludes 5 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price, before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the MS-DRG code on your bill matches exactly: 470.

Insurance Before you use insurance

Call your insurance company to confirm Decatur Memorial Hospital is in-network.
Ask your insurer whether prior approval is required for MS-DRG code 470.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Decatur Memorial Hospital

Compare: Hip or knee replacement (inpatient stay) at other IL hospitals

Blessing Hospital · Quincy $12,226
Alexian Brothers Medical Center 1 · Elk Grove Village $12,827
St Alexius Medical Center · Hoffman Estates $13,048
University of Illinois Hospital and Clinics · Chicago $13,087
Crawford Memorial Hospital · Robinson $13,322
Northwestern Medicine Delnor Community Hospital · Geneva $14,316
Edward Hospital · Naperville $14,765
Northwest Community Hospital 1 · Arlington Heights $14,777

Insurance negotiated median for the same procedure, sorted lowest first.