CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: HCA Florida Twin Cities Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $25,678
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.09x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at HCA Florida Twin Cities Hospital is $25,678. 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 1.09x the Medicare baseline. Located in 2190 Hwy 85 N, Niceville, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$25,678

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: $25,678 (109%)

Ins. Median: $25,678 (109% 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
Cigna	$2,374 - $78,075	10%
Avmed	$2,968 - $66,826	13%
United	$7,876 - $60,804	34%
Humana	$8,323 - $27,266	35%
Sunshine State Health Plan	$11,736	50%
Molina Healthcare	$13,318 - $25,678	57%
Wellmed	$23,740	101%
Regency Hospice	$24,225	103%
Blue Cross Blue Shield	$24,467 - $105,461	104%
Ultimate Health Plan	$24,709	105%
Aetna	$24,830 - $110,522	106%
Simply	$25,436	108%
American Health Plan	$25,678	109%
Healthspring Of Florida	$25,921	110%
Sunshine State	$26,042	111%
Wellcare	$26,042	111%
Gold Kidney Of Florida	$26,405	112%
Centurion	$26,647	113%
Florida Complete Care	$27,132	115%
Longevity Health Plan	$27,132	115%
Ndms Definitive Care	$30,281	129%
Oscar	$36,730	156%
Simply Healthcare	$162,943	693%

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 HCA Florida Twin Cities Hospital 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.