CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Rush University Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $25,490
Cash Discount Price: $34,864
vs. Medicare Baseline: 1.81x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Rush University Medical Center is $25,490. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $34,864. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.81x the Medicare baseline. Located in 1653 West Congress Parkway, Chicago, IL.

Cash / Self-Pay

$34,864

Average discount available for prompt cash payment at this facility.

Insurance Median

$25,490

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: $34,864 (248%)

Insurance Median: $25,490 (181%)

Cash: $34,864 (248% of Medicare)

Ins. Median: $25,490 (181% 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
UnitedHealthcare	$8,890 - $31,053	63%
Cigna	$20,012 - $37,714	142%
Aetna	$23,002 - $37,859	164%
Blue Cross Blue Shield	$23,002 - $37,997	164%
Devoted Mcr Adv - All Plans	$23,002	164%
Humana	$23,002	164%
Wellcare Mcr Adv - All Plans	$23,002	164%
Molina Fide-Snp	$23,922	170%
Meridian Dnsp	$24,152	172%
Zing Hlth Mcr Adv - All Plans	$24,382	174%
Ambetter / Centene	$31,053	221%
Molina Exch - All Other Plans	$31,283	223%

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 $34,864.
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 Rush University Medical Center 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.