CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: HCA Florida Raulerson Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $25,273
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.08x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at HCA Florida Raulerson Hospital is $25,273. 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 1.08x the Medicare baseline. Located in 1796 Hwy 441 North, Okeechobee, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$25,273

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: $25,273 (108%)

Ins. Median: $25,273 (108% 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
Avmed	$3,251 - $70,676	14%
Cigna	$4,535 - $38,592	19%
Humana	$4,630 - $33,333	20%
United	$6,000 - $47,315	26%
Molina	$11,098 - $25,513	47%
Sunshine State Health Plan	$11,652	50%
Wellmed	$23,347	99%
Veterans Evaluation Services	$24,069	102%
Blue Cross Blue Shield	$24,310 - $52,875	103%
Devoted Health	$24,551	104%
Ultimate Health Plan	$24,551	104%
Aetna	$24,671 - $54,353	105%
Freedom Health	$25,032	107%
Health Sun Health Plan	$25,032	107%
Optimum	$25,032	107%
Careplus	$25,273 - $27,680	108%
Simply Healthcare Plans	$25,273	108%
American Health Plan	$25,513	109%
Sunshine State	$25,754 - $26,476	110%
Centurion	$26,476	113%
Florida Complete Care	$26,476	113%
Longevity Health Plan	$26,476	113%
Solis Health Plan	$27,439	117%
Ndms Definitive Care	$30,087	128%
Oscar	$42,393	180%
Simply Healthcare	$236,401	1006%

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 Raulerson 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.