CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Los Robles Hospital & Medical Center

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $35,408
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.51x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Los Robles Hospital & Medical Center is $35,408. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.51x the Medicare baseline. Located in 215 W Janss Rd, Thousand Oaks, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$35,408

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%)

Insurance Median: $35,408 (151%)

Ins. Median: $35,408 (151% 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
Blue Shield	$2,717 - $36,116	12%
First Health	$2,768 - $3,785	12%
Onelegacy	$3,000	13%
Health Net	$4,784 - $8,580	20%
Cigna	$5,314 - $88,329	23%
Aetna	$5,713 - $35,408	24%
United	$8,666 - $48,715	37%
Assisted Hospice Care	$28,326	121%
Mission Hh Hospice	$28,326	121%
Vitas Healthcare	$28,326	121%
Brand New Day	$34,700 - $53,112	148%
Alignment Health Plan	$35,408	151%
Blue Cross Blue Shield	$35,408	151%
Buena Vista Hospice	$35,408	151%
Central Health Plan	$35,408	151%
Clever Care Of Golden State	$35,408 - $37,178	151%
Easy Choice Health Plan	$35,408	151%
Humana	$35,408	151%
La Care	$35,408	151%
Medcare Partners	$35,408 - $37,178	151%
Scan Health Plan	$35,408	151%
Tender Loving Care	$35,408	151%
Triwest Healthcare Alliance	$35,408	151%
Care1St Health Plan	$36,116	154%
Corvel Corporation	$45,833	195%
Ventura County Foundation	$46,296	197%

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 $X.
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 Los Robles Hospital & Medical Center 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.