Spinal fusion, single level (inpatient stay)
Facility: Mercy Specialty Hospital Southeast Kansas
Billing Code: 451 (MS-DRG)
- CPT Billing Code: 451
- Insurance Median: $21,955
- Cash Discount Price: $80,600
- vs. Medicare Baseline: 0.93x 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 | $12,081 - $21,955 | 51% |
| Medicaid / KanCare | $12,081 - $21,955 | 51% |
| Humana | $12,081 | 51% |
| Blue Cross Blue Shield | $12,231 - $39,537 | 52% |
| First Health Contracted [320128] | $19,806 | 84% |
| UnitedHealthcare | $21,955 - $25,074 | 93% |
| Cross Timbers Hospice [20098] | $21,955 | 93% |
| Medicare (plans) | $21,955 - $22,381 | 93% |
| Mercy Mgd Behavioral Health Contracted [320259] | $21,955 | 93% |
| Kindful Hospice Contracted [320434] | $21,955 | 93% |
| Elara Caring Aspire Hospice [20433] | $21,955 | 93% |
| Kindful Hospice [20434] | $21,955 | 93% |
| Cherokee Nation Health Serv Contracted [320066] | $21,955 | 93% |
| Medical Associates Health Contracted [320444] | $21,955 | 93% |
| Indian Health Service Contracted [320198] | $21,955 | 93% |
| Halo Hcr Inc Hospice [20432] | $21,955 | 93% |
| Globalhealth Contracted [320145] | $21,955 | 93% |
| Qual Choice Contracted [320325] | $21,955 | 93% |
| Halo Hcr Inc Hospice Contracted [320432] | $21,955 | 93% |
| Cigna | $21,955 - $38,477 | 93% |
| Pace Of The Ozarks Contracted [320518] | $21,955 | 93% |
| Mercy Hospice Okc [20252] | $21,955 | 93% |
| Centivo Contracted [320505] | $22,381 | 95% |
| Dept Of Veteran Affairs Contracted [320106] | $22,381 | 95% |
| United Medical Resources Contracted [320454] | $24,583 - $30,333 | 105% |
| Providrs Care Network Contracted [320484] | $25,197 | 107% |
| Medica Contracted [320239] | $27,097 | 115% |
| Show-Me Health Administrators Contracted [320483] | $29,836 | 127% |
| Tricare | $30,010 | 128% |
| Health Systems Inc Contracted [320174] | $30,333 | 129% |
| Healthscope Contracted [320182] | $30,333 | 129% |
| Insurance System Inc Contracted [320465] | $30,333 | 129% |
| Benefit Management Contracted [320052] | $30,333 | 129% |
| Point C Contracted [320238] | $30,333 | 129% |
| Health Choice Contracted [320166] | $40,619 | 173% |
Consumer Guidance & Cost Commentary
For the procedure "Spinal fusion, single level (inpatient stay)" at Mercy Specialty Hospital Southeast Kansas, the facility's cash median rate of $80,600 is significantly higher than the negotiated rates paid by most insurance plans, which range from $12,081 to $40,619. While the facility's gross charge is $123,999, commercial payers like Aetna, Medicaid/KanCare, and several contracted hospice organizations pay a flat rate of $21,955, whereas others such as Blue Cross Blue Shield and Cigna pay up to $39,537. It is important to note that these negotiated rates often include administrative overhead and are not necessarily the lowest possible price; in some cases, paying cash directly can be more cost-effective for patients with high-deductible plans if the insurance allowed amount exceeds the cash price. Patients should verify their specific plan's allowed amount before scheduling and ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% when paid upfront.
The facility's Medicare benchmark amount of $23,503.93 serves as a critical baseline for evaluating pricing fairness, as commercial negotiated rates frequently exceed this federal standard. While the data provided does not include specific Kansas or county average figures for comparison, the facility's median negotiated rate of $21,955 is notably lower than its gross charge, illustrating the impact of insurance contracts. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act,