CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Ascension St Vincent's Riverside

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $19,555
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.83x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Ascension St Vincent's Riverside is $19,555. 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 0.83x the Medicare baseline. Located in 1 Shircliff Way, Jacksonville, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$19,555

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: $19,555 (83%)

Ins. Median: $19,555 (83% 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
Coventry Ppo High Performance	$7,266	31%
Coventry Hmo	$8,850	38%
Blue Cross Blue Shield	$9,654 - $24,918	41%
North Florida Surgeons	$10,000	43%
Cigna	$14,800 - $23,700	63%
Avmed Empower	$14,888	63%
Humana	$16,012 - $19,751	68%
Aetna	$19,258 - $40,088	82%
Bc Advantage Mcr Replacement	$19,555	83%
Coventry Mcr Replacement Hmo	$19,555	83%
Heartland Of Hc	$19,555	83%
Medicare (plans)	$19,555 - $19,946	83%
Pace Place	$19,555	83%
Research Study Encore Borland-Groover	$19,555	83%
Veterans Administration	$19,555	83%
Wellcare	$19,555	83%
UnitedHealthcare	$19,683 - $19,751	84%
Careplus Mcr Replacement	$19,946	85%
Northwell Direct	$20,000	85%
Bright Health	$26,399	112%
Smarthealth	$27,377	116%
Oscar Health Plan	$31,288	133%
Employer Direct Healthcare	$34,222	146%
90 Degree Benefits	$35,199	150%
Avmed Exchange	$35,199	150%
Molina Exchange	$36,177	154%
Ambetter / Centene	$37,155	158%
Occunet	$43,999	187%

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 Ascension St Vincent's Riverside 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.