CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Southcoast Hospitals Group

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $39,728
Cash Discount Price: $47,983
vs. Medicare Baseline: 1.69x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Southcoast Hospitals Group is $39,728. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $47,983. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.69x the Medicare baseline. Located in 363 Highland Avenue, Fall River, MA.

Cash / Self-Pay

$47,983

Average discount available for prompt cash payment at this facility.

Insurance Median

$39,728

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$23,503.93

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $23,503.93 (100%)

Cash / Self-Pay: $47,983 (204%)

Insurance Median: $39,728 (169%)

Cash: $47,983 (204% of Medicare)

Ins. Median: $39,728 (169% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$29,169 - $79,847	124%
Blue Cross Blue Shield	$29,169	124%
Evercare [1010304]	$29,169	124%
Medicare (plans)	$29,169 - $38,619	124%
Tufts Senior Care Options [1010315]	$29,169	124%
UnitedHealthcare	$29,169 - $69,874	124%
Wellsense Health Plan Senior Care Options [1020208	$29,461	125%
Commonwealth Care Alliance [1080501]	$30,044 - $30,336	128%
Eternal Health [1010322]	$32,086	137%
Wellpoint [1000102]	$37,143	158%
Fallon [1000114]	$40,837	174%
Tufts [1010701]	$51,056 - $60,861	217%
Cigna	$60,941 - $72,645	259%
First Health [1000130]	$66,982 - $79,847	285%
Group Insurance Service Center [1013001]	$70,047 - $83,500	298%
Innovative Health Plan [1025001]	$70,047 - $83,500	298%
PHCS [1000125]	$70,047 - $83,500	298%
Priority Health [1015001]	$70,047 - $83,500	298%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $47,983.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 451.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Southcoast Hospitals Group is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 451.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.