Spinal fusion, single level (inpatient stay)
Facility: Saint Luke'S South Hospital
Billing Code: 451 (MS-DRG)
- CPT Billing Code: 451
- Insurance Median: $22,349
- Cash Discount Price: $162,259
- vs. Medicare Baseline: 0.95x 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 |
|---|---|---|
| UnitedHealthcare | $2,670 - $45,843 | 11% |
| Cigna | $3,500 | 15% |
| Medicaid / KanCare | $14,907 - $16,398 | 63% |
| Medicare (plans) | $21,008 - $26,819 | 89% |
| Blue Cross Blue Shield | $22,349 | 95% |
| Transplants-Case Rates [5750] | $22,349 - $100,213 | 95% |
| Commercial-Contracted [8000] | $35,759 | 152% |
| Aetna | $50,527 - $100,213 | 215% |
Consumer Guidance & Cost Commentary
For a single-level spinal fusion at Saint Luke's South Hospital in Overland Park, KS, the cash price is $162,259, which is significantly lower than the facility's gross charge of $270,431. While the hospital's negotiated rates with major payers like UnitedHealthcare and Aetna range from $2,670 to $100,213, the cash rate often represents the most affordable option for patients with high-deductible plans or those without insurance. It is important to note that commercial negotiated rates frequently exceed cash prices due to administrative overhead and contract structures; for instance, the median negotiated rate of $22,349 is still higher than the cash price, though individual plan contracts may vary widely. Patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as paying in full upfront can sometimes bypass the standard insurance billing cycle to secure a lower total cost.
When evaluating this cost, it is crucial to compare the facility's pricing against the Medicare benchmark rather than the hospital's inflated chargemaster list. The Medicare reimbursement rate for this procedure is $23,503.93, which serves as the objective baseline for fair pricing. Although the data does not provide specific state or county average comparisons for this specific DRG, the Medicare rate reveals that the facility's cash price is approximately 6.9 times the federal benchmark, while the gross charge is over 11 times higher. To avoid unexpected balance billing, patients should verify their insurance network status and ensure they do not sign away rights to dispute out-of-network charges, as federal protections like the No Surprises Act