CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Progress West Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $27,234
Cash Discount Price: $66,024
vs. Medicare Baseline: 1.16x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Progress West Hospital is $27,234. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $66,024. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.16x the Medicare baseline. Located in 2 Progress Point Pkwy, Ofallon, MO.

Cash / Self-Pay

$66,024

Average discount available for prompt cash payment at this facility.

Insurance Median

$27,234

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: $66,024 (281%)

Insurance Median: $27,234 (116%)

Cash: $66,024 (281% of Medicare)

Ins. Median: $27,234 (116% 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
Cigna	$12,767 - $27,644	54%
Aetna	$24,234 - $61,196	103%
Blue Cross Blue Shield	$24,234 - $50,922	103%
Essence Healthcare [221]	$24,234	103%
Humana	$24,234	103%
UnitedHealthcare	$24,234 - $52,394	103%
Cox Health [757]	$25,445	108%
Devoted Health Plan [847]	$25,445	108%
Medica [662]	$25,445	108%
Apwu Health Plan [216]	$26,824	114%
Nalc Health Benefit Plan [242]	$26,824	114%
Priority Health [648]	$26,824	114%
Consociate [478]	$33,198 - $38,175	141%
Health Alliance [224]	$34,944	149%
Sarah Bush Lincoln [636]	$38,175	162%
Healthscope Benefits [258]	$52,394	223%
Allied Benefits [498]	$61,196	260%
Coresource [497]	$61,196	260%
Fmh Benefit Service Inc [222]	$61,196	260%
Mail Handlers [495]	$61,196	260%

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 $66,024.
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 Progress West Hospital 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.