CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Alton Memorial Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $18,710
Cash Discount Price: $37,980
vs. Medicare Baseline: 1.33x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Alton Memorial Hospital is $18,710. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $37,980. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.33x the Medicare baseline. Located in One Memorial Drive, Alton, IL.

Cash / Self-Pay

$37,980

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,710

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$14,044.15

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14,044.15 (100%)

Cash / Self-Pay: $37,980 (270%)

Insurance Median: $18,710 (133%)

Cash: $37,980 (270% of Medicare)

Ins. Median: $18,710 (133% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $14,044.15 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
Cigna	$10,469 - $18,710	75%
Aetna	$15,917 - $24,702	113%
Blue Cross Blue Shield	$15,917 - $32,825	113%
Essence Healthcare [221]	$15,917	113%
Humana	$15,917 - $37,912	113%
UnitedHealthcare	$15,917 - $16,466	113%
Healthscope Benefits [258]	$16,466	117%
Cox Health [757]	$16,713	119%
Devoted Health Plan [847]	$16,713	119%
Medica [662]	$16,713	119%
Apwu Health Plan [216]	$18,710	133%
Nalc Health Benefit Plan [242]	$18,710	133%
Priority Health [648]	$18,710	133%
Consociate [478]	$20,246 - $23,284	144%
Health Alliance [224]	$21,414	152%
Sarah Bush Lincoln [636]	$23,284	166%
Allied Benefits [498]	$24,702	176%
Coresource [497]	$24,702	176%
Fmh Benefit Service Inc [222]	$24,702	176%
Mail Handlers [495]	$24,702	176%

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 $37,980.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 470.

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 470.
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.