CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Decatur Memorial Hospital

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $1,598
Cash Discount Price: $6,424
vs. Medicare Baseline: 6.56x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Decatur Memorial Hospital is $1,598. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,424. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 6.56x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$6,424

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,598

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)

Cash / Self-Pay: $6,424 (2635%)

Insurance Median: $1,598 (656%)

Cash: $6,424 (2635% of Medicare)

Ins. Median: $1,598 (656% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 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 656% of the Medicare baseline (a markup of 556%). 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
Aetna	$189 - $4,310	78%
Blue Cross Blue Shield	$189 - $6,424	78%
Coventry	$189 - $3,257	78%
Health Alliance	$189 - $4,272	78%
Humana	$189 - $1,561	78%
Medicare (plans)	$189 - $252	78%
UnitedHealthcare	$189 - $6,424	78%
Veterans Administration	$189 - $252	78%
Tricare	$192 - $256	79%
Wellcare	$252	103%
Plain Church Medical Group	$279 - $2,891	114%
Medicaid / KanCare	$303 - $309	124%
Caterpillar	$575	236%
Illinois Workers Compensation	$1,429 - $1,634	586%
Hfn	$1,536 - $4,818	630%
Commercial Workers Compensation	$1,553	637%
Cigna	$1,854 - $2,994	761%
Mennonite Churches	$2,248	922%
Health Alliance Mh Employee Plan	$2,955	1212%
6 Degrees Health	$3,854	1581%
Hopetrust	$3,854	1581%
Hst	$3,854	1581%
Phcs Savility	$4,176	1713%
Phcs Multiplan Ppo	$4,368	1792%
Healthlink	$4,407	1808%
Corvel	$4,625	1897%
Consociate	$4,754	1950%
Liability	$6,424	2635%

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 $6,424.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 73721.

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 73721.
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.