CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Larkin Community Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $2,485
Cash Discount Price: $7,662
vs. Medicare Baseline: 0.11x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Larkin Community Hospital is $2,485. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,662. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 0.11x the Medicare baseline. Located in 7031 Sw 62Nd Ave, South Miami, FL.

Cash / Self-Pay

$7,662

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,485

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: $7,662 (33%)

Insurance Median: $2,485 (11%)

Cash: $7,662 (33% of Medicare)

Ins. Median: $2,485 (11% 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	$2,485	11%
Community Care Phks Mcaid-All Other Plans	$2,485	11%
Humana	$2,485	11%
Magellan Complete Care	$2,485	11%
Medicaid / KanCare	$2,485 - $2,609	11%
Odyssey Health Mcaid Ip Only	$2,485	11%
UnitedHealthcare	$2,485 - $10,946	11%
Oscar Health-All Plans	$3,811	16%
Star Network-All Plans	$4,378	19%
First Med Hp Of Fl-All Plans	$6,568	28%
Odyssey Health Ip Only-All Other Plans	$10,399	44%
Avmed-All Plans	$10,946	47%
Blue Cross Blue Shield	$10,946	47%
Bright Health-All Other Plans	$10,946	47%
Cigna	$10,946	47%
United Prop Casualty-All Plans	$10,946	47%

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 $7,662.
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 Larkin Community 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.