CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: HCA Florida North Florida Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $30,426
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.29x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at HCA Florida North Florida Hospital is $30,426. 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 1.29x the Medicare baseline. Located in 6500 W Newberry Rd, Gainesville, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$30,426

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: $30,426 (129%)

Ins. Median: $30,426 (129% 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	$3,116 - $70,836	13%
Humana	$4,954 - $31,462	21%
United	$6,086 - $71,338	26%
Sunshine State Health Plan	$11,680	50%
Molina Healthcare	$13,318 - $31,168	57%
Hospice Of North Central Fl	$26,463	113%
Oscar	$26,761	114%
Wellmed	$28,816	123%
United Behavioral Health	$29,404	125%
Va Purchased Care Program	$29,404	125%
Blue Cross Blue Shield	$29,698 - $65,436	126%
Capital Health Plan	$29,698 - $62,487	126%
Ultimate Health Plan	$29,992	128%
Aetna	$30,139 - $47,419	128%
Simply	$30,874	131%
American Health Plan	$31,168	133%
Sunshine State	$31,609	134%
Wellcare	$31,609	134%
Gold Kidney Of Florida	$32,050	136%
Centurion	$32,344	138%
Longevity Health Plan	$32,932	140%
Align Senior Care	$34,696	148%
Florida Complete Care	$34,696	148%
Ndms Definitive Care	$36,755	156%
Evolutions	$52,355	223%
Corizon Phs	$58,808	250%
Simply Healthcare	$130,889	557%

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 North Florida 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.