Alton, IL 62002 · CMS Certification Number 140002. What Medicare pays this hospital for knee, hip and shoulder replacement, what it lists, how it compares, and what a surgery center nearby is paid.
| Operation | Inpatient avg total payment Medicare + patient share | List price | List ÷ total | Outpatient Medicare allowed |
|---|---|---|---|---|
| Hip or knee replacement | $14,616 | $64,101 | 4.4× | $12,002 |
| Shoulder replacement | — | — | — | $17,185 |
| MS-DRG 470 | Median across insurers | × Medicare total payment | Lowest–highest insurer | Insurers |
|---|---|---|---|---|
| Hip or knee replacement | $22,524 | 1.5× | $16,466–$37,912 | 8 |
| Insurer | Median negotiated, MS-DRG 470 | × Medicare total payment | Plans |
|---|---|---|---|
| Humana | $37,912 | 2.6× | 1 |
| Elevance/Anthem/Empire | $29,751 | 2.0× | 1 |
| Aetna | $24,702 | 1.7× | 1 |
| Sarah Bush Lincoln | $23,284 | 1.6× | 1 |
| Consociate | $21,765 | 1.5× | 1 |
| Health Alliance | $21,414 | 1.5× | 1 |
| Cigna | $18,710 | 1.3× | 1 |
| UnitedHealthcare | $16,466 | 1.1× | 1 |
From the hospital's price-transparency file (2025-12-15); commercial plans, dollar-amount contracts only.
From the hospital's price-transparency file (2025-12-15); commercial plans, dollar-amount contracts only.
Complications after hip or knee replacement: 3.7% (no different from the national rate). Readmissions: 6.6%. Overall Care Compare rating: 4 of 5 stars. Nonprofit · Acute · 222 beds
Illinois requires a certificate of need for new surgery centers.
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In 2024 the average total payment to Alton Memorial Hospital for an inpatient hip or knee replacement stay was $14,616 (MS-DRG 470, 35 Medicare stays; Medicare's payment plus the patient's deductible and coinsurance), and the Medicare allowed amount averaged $12,002 per outpatient case (APC 5115, 202 cases).
The hospital's average list (chargemaster) price for an inpatient hip or knee replacement was $64,101, 4.4× the average total payment for a Medicare stay. Almost nobody pays the list price; it matters for uninsured bills and percent-of-charge contracts.
Yes for Medicare facility payments. Anderson Surgery Center LLC, an orthopedic surgery center 13.3 mi away, is paid about $8,800 by Medicare for a knee replacement (CPT 27447), $5,816 less than an inpatient stay at Alton Memorial Hospital. Not every patient is a surgery-center candidate.
Alton Memorial Hospital's average total payment per Medicare stay is lower than 64% of the 45 Illinois hospitals that report inpatient hip or knee replacement.
From the hospital's own price-transparency file, commercial plans' negotiated rates for MS-DRG 470 have a median of $22,524 across 8 insurers, ranging from $16,466 to $37,912.