CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Alton Memorial Hospital

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $10,545
Cash Discount Price: $16,223
vs. Medicare Baseline: 1.86x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Alton Memorial Hospital is $10,545. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $16,223. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 1.86x the Medicare baseline. Located in One Memorial Drive, Alton, IL.

Cash / Self-Pay

$16,223

Average discount available for prompt cash payment at this facility.

Insurance Median

$10,545

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$5,675.87

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $5,675.87 (100%)

Cash / Self-Pay: $16,223 (286%)

Insurance Median: $10,545 (186%)

Cash: $16,223 (286% of Medicare)

Ins. Median: $10,545 (186% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $5,675.87 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
Aetna	$6,829 - $15,724	120%
Blue Cross Blue Shield	$6,829 - $12,564	120%
Essence Healthcare [221]	$6,829	120%
Humana	$6,829 - $9,443	120%
UnitedHealthcare	$6,829 - $12,644	120%
Cox Health [757]	$7,170	126%
Devoted Health Plan [847]	$7,170	126%
Medica [662]	$7,170	126%
Cigna	$8,051 - $12,274	142%
Health Alliance [224]	$8,591	151%
Consociate [478]	$9,169 - $10,545	162%
Sarah Bush Lincoln [636]	$10,545	186%
Apwu Health Plan [216]	$12,274	216%
Nalc Health Benefit Plan [242]	$12,274	216%
Priority Health [648]	$12,274	216%
Healthscope Benefits [258]	$12,644	223%
Allied Benefits [498]	$15,724	277%
Coresource [497]	$15,724	277%
Fmh Benefit Service Inc [222]	$15,724	277%
Mail Handlers [495]	$15,724	277%

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 $16,223.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 392.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Alton Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 392.
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.