CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Alton Memorial Hospital

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $27,790
Cash Discount Price: $46,428
vs. Medicare Baseline: 2.17x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Alton Memorial Hospital is $27,790. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $46,428. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 2.17x the Medicare baseline. Located in One Memorial Drive, Alton, IL.

Cash / Self-Pay

$46,428

Average discount available for prompt cash payment at this facility.

Insurance Median

$27,790

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%)

Cash / Self-Pay: $46,428 (363%)

Insurance Median: $27,790 (217%)

Cash: $46,428 (363% of Medicare)

Ins. Median: $27,790 (217% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 217% of the Medicare baseline (a markup of 117%). 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	$14,605 - $46,347	114%
Blue Cross Blue Shield	$14,605 - $34,402	114%
Essence Healthcare [221]	$14,605	114%
Humana	$14,605 - $37,387	114%
UnitedHealthcare	$14,605 - $28,594	114%
Cox Health [757]	$15,335	120%
Devoted Health Plan [847]	$15,335	120%
Medica [662]	$15,335	120%
Cigna	$18,477 - $29,747	144%
Health Alliance [224]	$19,918	156%
Consociate [478]	$21,099 - $24,265	165%
Sarah Bush Lincoln [636]	$24,265	189%
Healthscope Benefits [258]	$28,594	223%
Apwu Health Plan [216]	$29,747	232%
Nalc Health Benefit Plan [242]	$29,747	232%
Priority Health [648]	$29,747	232%
Allied Benefits [498]	$46,347	362%
Coresource [497]	$46,347	362%
Fmh Benefit Service Inc [222]	$46,347	362%
Mail Handlers [495]	$46,347	362%

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 $46,428.
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 Alton 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.