CMS Price Transparency Data
Spinal fusion, single level (inpatient stay)
Facility: Mercy Hospital Joplin
Billing Code: 451 (MS-DRG)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 451
- Insurance Median: $25,001
- Cash Discount Price: $63,048
- vs. Medicare Baseline: 1.06x Medicare
The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Mercy Hospital Joplin is $25,001. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $63,048. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.06x the Medicare baseline. Located in 100 Mercy Way, Joplin, MO.
Cash / Self-Pay
$63,048
Average discount available for prompt cash payment at this facility.
Insurance Median
$25,001
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: $63,048 (268%)
Insurance Median: $25,001 (106%)
Cash: $63,048 (268% of Medicare)
Ins. Median: $25,001 (106% 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.
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 |
|---|---|---|
| Ambetter / Centene | $2,728 | 12% |
| Home State Health Plan Contracted [320187] | $2,728 | 12% |
| Medicaid / KanCare | $2,728 - $25,001 | 12% |
| Novasys Contracted [320285] | $2,728 | 12% |
| Aetna | $12,081 - $25,001 | 51% |
| Humana | $12,081 - $23,776 | 51% |
| Blue Cross Blue Shield | $13,421 - $36,972 | 57% |
| Indian Health Service Contracted [320198] | $18,185 - $25,001 | 77% |
| Health Systems Inc Contracted [320174] | $20,652 | 88% |
| Insurance System Inc Contracted [320465] | $20,652 | 88% |
| Benefit Management Contracted [320052] | $22,093 | 94% |
| Centivo Contracted [320505] | $25,001 | 106% |
| Champva [20065] | $25,001 | 106% |
| Cherokee Nation Health Serv Contracted [320066] | $25,001 | 106% |
| Cigna | $25,001 - $38,477 | 106% |
| Cross Timbers Hospice [20098] | $25,001 | 106% |
| Dept Of Veteran Affairs Contracted [320106] | $25,001 | 106% |
| Elara Caring Aspire Hospice [20433] | $25,001 | 106% |
| Globalhealth Contracted [320145] | $25,001 | 106% |
| Halo Hcr Inc Hospice Contracted [320432] | $25,001 | 106% |
| Halo Hcr Inc Hospice [20432] | $25,001 | 106% |
| Kindful Hospice Contracted [320434] | $25,001 | 106% |
| Kindful Hospice [20434] | $25,001 | 106% |
| Medicare (plans) | $25,001 - $25,776 | 106% |
| Mercy Hospice Okc [20252] | $25,001 | 106% |
| Mercy Mgd Behavioral Health Contracted [320259] | $25,001 | 106% |
| Pace Of The Ozarks Contracted [320518] | $25,001 | 106% |
| Provider Partners Health Plans Contracted [320450] | $25,001 | 106% |
| Qual Choice Contracted [320325] | $25,001 | 106% |
| UnitedHealthcare | $25,001 - $35,628 | 106% |
| Providrs Care Network Contracted [320484] | $25,197 | 107% |
| First Health Contracted [320128] | $26,260 | 112% |
| Medica Contracted [320239] | $27,097 | 115% |
| Point C Contracted [320238] | $27,428 | 117% |
| Mercy Benefit Admin Contracted [320251] | $27,751 - $28,415 | 118% |
| 90 Degree Benefits Contracted [320436] | $28,415 | 121% |
| Show-Me Health Administrators Contracted [320483] | $28,415 - $29,836 | 121% |
| Tricare | $30,010 | 128% |
| Healthscope Contracted [320182] | $30,776 | 131% |
| Healthlink Contracted [320179] | $31,800 - $34,979 | 135% |
| United Medical Resources Contracted [320454] | $33,367 - $35,628 | 142% |
| Health Choice Contracted [320166] | $40,619 | 173% |