Spinal fusion, single level (inpatient stay)
Facility: Menorah Medical Center
Billing Code: 451 (MS-DRG)
- CPT Billing Code: 451
- Insurance Median: $24,948
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.06x 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 |
|---|---|---|
| United | $2,428 - $56,579 | 10% |
| Blue Cross Blue Shield | $3,499 - $55,379 | 15% |
| Humana | $4,466 - $24,948 | 19% |
| Multiplan | $6,522 | 28% |
| Amerigroup | $14,907 | 63% |
| Healthyblue | $15,205 | 65% |
| Aetna | $15,503 - $62,557 | 66% |
| Unicare | $15,503 | 66% |
| Coventry | $24,574 | 105% |
| Celtic | $25,447 | 108% |
| Devoted Health | $25,447 | 108% |
| Wellcare | $25,447 | 108% |
| Nhc Advantage | $25,697 | 109% |
| Cigna | $25,946 - $71,935 | 110% |
| Pyramid Life | $27,443 | 117% |
| Universal Healthcare | $28,441 | 121% |
| Oscar | $35,147 | 150% |
| Wppa Providrs Care Network | $50,000 | 213% |
| Ambetter / Centene | $51,439 | 219% |
Consumer Guidance & Cost Commentary
For the Spinal fusion, single level procedure at Menorah Medical Center in Overland Park, KS, the Medicare benchmark rate is $23,503.93. This federal baseline represents the scientifically validated "true cost" of care, serving as the objective standard against which commercial rates are measured. While the facility's median negotiated rate across payers is $24,948, this figure is only 1.1 times the Medicare amount, indicating that the commercial pricing is relatively close to the fair market value rather than significantly inflated. It is important to note that cash-pay options are not listed for this specific code, so patients relying on self-pay or prompt-pay discounts should contact the hospital directly to inquire about potential fee reductions before scheduling, as these upfront incentives can bypass the administrative overhead that typically inflates insurance billing cycles.
The pricing landscape for this service varies significantly among the 20 commercial payers, with negotiated rates ranging from a low of $2,428 for United to a high of $71,935 for Cigna. Although the data does not provide explicit comparisons to Kansas or the broader state averages, the wide disparity in allowed amounts highlights the critical need for patients to verify their specific plan's negotiated rate prior to treatment. Commercial rates often include administrative costs for claims processing and contract management, which can increase the baseline price by 20% to 40% compared to the pure service cost. Patients should be aware that while being in-network protects against balance billing for emergency services under the No Surprises Act, the final amount owed depends entirely on the specific contract between the insurer and the hospital, making it essential to review the itemized bill for any unbund