Spinal fusion, single level (inpatient stay)
Facility: Kansas City Orthopaedic Institute
Billing Code: 451 (MS-DRG)
- CPT Billing Code: 451
- Insurance Median: $20,765
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.88x 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 | $20,662 | 88% |
| Cigna | $20,662 | 88% |
| Aetna | $20,662 | 88% |
| Blue Cross Blue Shield | $20,868 - $23,046 | 89% |
Consumer Guidance & Cost Commentary
For the Spinal fusion, single level procedure at Kansas City Orthopaedic Institute in Leawood, KS, the negotiated rates for major payers like UnitedHealthcare, Cigna, and Aetna are set at $20,662, while Blue Cross Blue Shield ranges from $20,868 to $23,046 across three plans. These commercial rates are notably higher than the facility's median negotiated rate of $20,765 and exceed the Medicare benchmark of $23,503.93 by a factor of roughly 0.9, indicating the facility's pricing is slightly below the federal cost baseline. Because cash prices are not listed for this service, patients with high-deductible plans should verify if paying out-of-pocket directly could result in lower costs than their insurance allowed amount, as commercial negotiated rates often include administrative overhead that can inflate the final bill.
Patients should be aware that while this facility is an in-network Acute Care Hospital, balance billing remains a risk if any ancillary services, such as emergency physicians or specific lab tests, are provided by out-of-network providers. Under the No Surprises Act, patients are protected from balance billing for these non-emergency services at in-network facilities, but it is crucial to request a full itemized bill before paying to ensure no unbundled codes or services not rendered are included. Additionally, since the facility is physician-owned, patients should proactively ask about self-pay or prompt-pay discounts before scheduling, as paying in full upfront can often bypass the costly insurance claims cycle and reduce the total amount owed.