CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: St Louis Childrens Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $83,494
Cash Discount Price: $77,688
vs. Medicare Baseline: 3.55x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at St Louis Childrens Hospital is $83,494. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $77,688. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 3.55x the Medicare baseline. Located in One Childrens Place, Saint Louis, MO.

Cash / Self-Pay

$77,688

Average discount available for prompt cash payment at this facility.

Insurance Median

$83,494

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: $77,688 (331%)

Insurance Median: $83,494 (355%)

Cash: $77,688 (331% of Medicare)

Ins. Median: $83,494 (355% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 355% of the Medicare baseline (a markup of 255%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$6,027 - $10,114	26%
Health Alliance [224]	$7,300	31%
Apwu Health Plan [216]	$10,114	43%
Nalc Health Benefit Plan [242]	$10,114	43%
Priority Health [648]	$10,114	43%
Blue Cross Blue Shield	$64,083 - $65,928	273%
Healthscope Benefits [258]	$83,494	355%
UnitedHealthcare	$83,494	355%
Consociate [478]	$84,934 - $89,181	361%
Sarah Bush Lincoln [636]	$84,934	361%
Aetna	$145,217	618%
Allied Benefits [498]	$145,217	618%
Coresource [497]	$145,217	618%
Fmh Benefit Service Inc [222]	$145,217	618%
Mail Handlers [495]	$145,217	618%

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 $77,688.
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 St Louis Childrens 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.