Spinal fusion, single level (inpatient stay)
Facility: Children'S Mercy South
Billing Code: 451 (MS-DRG)
- CPT Billing Code: 451
- Insurance Median: $16,969
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.72x 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 | $15,908 | 68% |
| Healthy Blue | $16,969 | 72% |
| Medicaid / KanCare | $17,726 | 75% |
Consumer Guidance & Cost Commentary
For the procedure "Spinal fusion, single level (inpatient stay)" at Children's Mercy South in Overland Park, KS, the facility's negotiated rates range from $15,908 to $17,726 depending on the insurance carrier, with a median negotiated amount of $16,969. This commercial rate is significantly lower than the Medicare benchmark of $23,503.93, reflecting the typical administrative overhead and contract structures that commercial payers utilize. While the facility is a voluntary non-profit, patients should be aware that cash-pay options are not listed in this report; however, hospitals often offer prompt-pay discounts of 20% to 50% for upfront payments, which can result in a total cost lower than the insurance negotiated rate. It is crucial to request self-pay classification and a prompt-pay discount before scheduling to avoid automatic claims submission that would void these savings.
The data provided does not include specific cash, median paid, or state/county average figures for this specific code, so direct comparisons to broader regional pricing standards cannot be made from this dataset alone. However, the absence of a listed cash median suggests that the facility may not have published a specific cash price for this service, or the rate is bundled within the negotiated structure. Patients should verify their specific plan's deductible status, as commercial rates often apply even if the patient has not yet met their annual deductible. To ensure transparency and avoid unexpected balance billing, consumers should always request an itemized, CPT-coded bill before finalizing payment and dispute any summary invoices that obscure individual line items.