CMS Price Transparency Data
Spinal fusion, single level (inpatient stay)
Facility: Mercy Hospital Jefferson
Billing Code: 451 (MS-DRG)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 451
- Insurance Median: $29,429
- Cash Discount Price: $33,837
- vs. Medicare Baseline: 1.25x Medicare
The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Mercy Hospital Jefferson is $29,429. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $33,837. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.25x the Medicare baseline. Located in 1400 Us Highway 61, Crystal City, MO.
Cash / Self-Pay
$33,837
Average discount available for prompt cash payment at this facility.
Insurance Median
$29,429
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: $33,837 (144%)
Insurance Median: $29,429 (125%)
Cash: $33,837 (144% of Medicare)
Ins. Median: $29,429 (125% 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 | $3,478 | 15% |
| Home State Health Plan Contracted [320187] | $3,478 | 15% |
| Medicaid / KanCare | $3,478 | 15% |
| Novasys Contracted [320285] | $3,478 | 15% |
| Healthlink Contracted [320179] | $4,133 - $43,727 | 18% |
| Blue Cross Blue Shield | $12,083 - $65,241 | 51% |
| Mercy Benefit Admin Contracted [320251] | $23,737 - $29,429 | 101% |
| Mercy Benefit Admin [20251] | $23,737 - $29,429 | 101% |
| American Health Advantage Of Mo Mcr [10473] | $24,300 | 103% |
| Cherokee Nation Health Serv Contracted [320066] | $24,300 | 103% |
| Cross Timbers Hospice [20098] | $24,300 | 103% |
| Dept Of Veteran Affairs Contracted [320106] | $24,300 | 103% |
| Elara Caring Aspire Hospice Contracted [320433] | $24,300 | 103% |
| Elara Caring Aspire Hospice [20433] | $24,300 | 103% |
| Globalhealth Contracted [320145] | $24,300 | 103% |
| Halo Hcr Inc Hospice Contracted [320432] | $24,300 | 103% |
| Halo Hcr Inc Hospice [20432] | $24,300 | 103% |
| Humana | $24,300 - $24,770 | 103% |
| Indian Health Service Contracted [320198] | $24,300 | 103% |
| Kindful Hospice Contracted [320434] | $24,300 | 103% |
| Kindful Hospice [20434] | $24,300 | 103% |
| Medicare (plans) | $24,300 - $24,770 | 103% |
| Mercy Hospice Okc [20252] | $24,300 | 103% |
| Pace Of The Ozarks Contracted [320518] | $24,300 | 103% |
| Qual Choice Contracted [320325] | $24,300 | 103% |
| UnitedHealthcare | $24,300 - $38,607 | 103% |
| Aetna | $24,770 - $37,718 | 105% |
| Centivo Contracted [320505] | $24,770 | 105% |
| Cigna | $24,770 - $30,896 | 105% |
| Healthscope Contracted [320182] | $24,770 | 105% |
| Hope Trust Contracted [320488] | $24,770 | 105% |
| Medica Contracted [320239] | $26,121 | 111% |
| Provider Partners Health Plans Contracted [320450] | $26,777 | 114% |
| Show-Me Health Administrators Contracted [320483] | $28,570 - $29,997 | 122% |
| Aither Health Contracted [320449] | $29,429 | 125% |
| Aither Health [20449] | $29,429 | 125% |
| Auxiant Contracted [320462] | $29,429 | 125% |
| Ebms Contracted [320493] | $29,429 | 125% |
| Edison Health Solutions Contracted [320502] | $29,429 | 125% |
| Imagine 360 Contracted [320494] | $29,429 | 125% |
| Reflect Health Contracted [320492] | $29,429 | 125% |
| Yuzu Health Contracted [320521] | $29,429 | 125% |
| Tricare | $31,726 | 135% |
| United Medical Resources Contracted [320454] | $38,607 | 164% |
| Preferred Health Plan Contracted [320522] | $43,348 | 184% |
| First Health Contracted [320128] | $55,976 | 238% |
| Mercy Mgd Behavioral Health Contracted [320259] | $55,976 | 238% |
| Multiplan Contracted [320270] | $55,976 | 238% |
| Private Health Care Systems Contracted [320320] | $55,976 | 238% |