Spinal fusion, single level (inpatient stay)
Facility: Susan B Allen Memorial Hospital
Billing Code: 451 (MS-DRG)
- CPT Billing Code: 451
- Insurance Median: $757
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.03x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
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 | $32,881 | 140% |
Consumer Guidance & Cost Commentary
For the Spinal fusion, single level procedure at Susan B Allen Memorial Hospital in El Dorado, KS, the facility's negotiated rate is $757.00, which is significantly lower than the Aetna payment of $32,881.00 for this service. While the facility is a voluntary non-profit acute care hospital, the data indicates that cash and median paid rates are not available for this specific code. Patients should be aware that cash-pay options can sometimes result in lower out-of-pocket costs if their insurance negotiated rate exceeds the cash price, though current data does not provide a specific cash amount to compare. It is always advisable to contact the hospital directly to inquire about self-pay or prompt-pay discounts before scheduling, as these upfront payment incentives can reduce administrative fees and improve immediate liquidity for the patient.
This procedure is categorized under MS-DRG 451, and the Medicare benchmark amount for this service is $23,503.93. The negotiated rate of $757.00 represents a substantial discount compared to the Medicare benchmark, aligning with fair pricing principles that typically range between 120% and 150% of the Medicare rate. If a patient receives a bill that includes balance billing from out-of-network providers, such as emergency physicians or lab services, they may be entitled to protections under the No Surprises Act, which bans balance billing for non-emergency services at in-network facilities. To ensure accuracy and avoid errors, patients should request a full itemized bill before making any payments, as summary bills often obscure individual charges and may include unbundled codes or services not rendered. Disputing any discrepancies in writing to the billing