CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Scripps Memorial Hospital - Encinitas

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $31,339
Cash Discount Price: $111,502
vs. Medicare Baseline: 1.33x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Scripps Memorial Hospital - Encinitas is $31,339. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $111,502. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.33x the Medicare baseline. Located in 354 Santa Fe Drive, Encinitas, CA.

Cash / Self-Pay

$111,502

Average discount available for prompt cash payment at this facility.

Insurance Median

$31,339

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$23,503.93

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $23,503.93 (100%)

Cash / Self-Pay: $111,502 (474%)

Insurance Median: $31,339 (133%)

Cash: $111,502 (474% of Medicare)

Ins. Median: $31,339 (133% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $23,503.93 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	$31,339 - $44,667	133%
Alignment Health Plan [443]	$31,339	133%
Astiva Mcr Adv [464]	$31,339	133%
Bc Mcr Adv [830]	$31,339	133%
Blue Cross Blue Shield	$31,339	133%
Bs Mcr Adv [829]	$31,339	133%
Central Health Mcr Adv [441]	$31,339	133%
Cigna	$31,339 - $103,638	133%
Clever Care Mcr Adv [465]	$31,339	133%
D-Snp Mcr Adv [889]	$31,339	133%
Dsnp/Csnp - Generic [458]	$31,339	133%
Family Health Centers Pace Mcr Adv Hmo [556]	$31,339	133%
Family Health Centers Pace Medi-Cal [555]	$31,339	133%
Gary And Mary West Pace Medi-Cal Hmo [557]	$31,339	133%
Gpmg/Altura - Mcr Adv [888]	$31,339	133%
Hn Mcr Adv [832]	$31,339	133%
Humana	$31,339	133%
Integrated Health Partners - Mcr Adv [895]	$31,339	133%
Kaiser Northern Ca Region Mcr Adv [386]	$31,339	133%
La Care Mcr Adv Hmo [612]	$31,339	133%
Mc Alignment [917]	$31,339	133%
Mc Blue Shield Promise Health Plan [914]	$31,339	133%
Mc Blue Shield [902]	$31,339	133%
Mc Health Net [904]	$31,339	133%
Mc Scan [905]	$31,339	133%
Mc United [906]	$31,339	133%
Medicare (plans)	$31,339	133%
San Diego Pace Medi-Cal [553]	$31,339	133%
Scan Mcr Adv [835]	$31,339	133%
Scan [500]	$31,339	133%
Scan [818]	$31,339	133%
Sharp Comm Med Grp Mcr Adv [840]	$31,339	133%
Sharp Health Plan Mcr Adv [531]	$31,339	133%
Sharp Health Plan Mcr Adv [897]	$31,339	133%
Sharp Rees Stealy Med Grp Mcr Adv [841]	$31,339	133%
St Paul'S Pace Medi-Cal [551]	$31,339	133%
Ucsd Mcr Adv [873]	$31,339	133%
Uh Mcr Adv [831]	$31,339	133%
Uh Palomar Health Mcr Adv [885]	$31,339	133%
UnitedHealthcare	$31,339 - $36,532	133%
Health Net [340]	$31,575	134%
Prime Healthcare [614]	$31,575	134%
Mpmg Mcr Adv [836]	$36,532	155%
Mpmg [800]	$36,532	155%
Ocn Mcr Adv [890]	$36,532	155%
Palomar Health [892]	$44,667	190%
Sharp Comm Med Grp [812]	$44,667 - $103,638	190%
Sharp Rees Stealy Med Grp [811]	$44,667 - $103,638	190%
Ucsd [807]	$44,667 - $103,638	190%
Veba Med Grp [813]	$44,667	190%

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 $111,502.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 451.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Scripps Memorial Hospital - Encinitas is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 451.
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.