CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Southern Hills Hospital and Medical Center

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $34,280
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.46x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Southern Hills Hospital and Medical Center is $34,280. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.46x the Medicare baseline. Located in 9300 West Sunset Rd, Las Vegas, NV.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$34,280

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%)

Insurance Median: $34,280 (146%)

Ins. Median: $34,280 (146% 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
Sierra	$2,732 - $25,842	12%
Multiplan	$3,186	14%
First Health	$3,456	15%
Hometown Health Providers	$3,973 - $4,612	17%
Prominence Healthfirst	$4,095	17%
Health Services Coalition	$4,110	17%
Aetna	$4,205 - $43,098	18%
United	$5,006 - $34,098	21%
Cigna	$6,540 - $74,083	28%
Community Care Health	$17,900	76%
Procare Hospice	$30,199	128%
Unified Care Hospice	$30,199	128%
Hometown Health Mcr	$34,462	147%
Humana	$34,462 - $35,528	147%
Alignment Health Plan	$35,528	151%
Ambetter / Centene	$35,528 - $63,950	151%
Blue Cross Blue Shield	$35,528 - $62,098	151%
Select Health	$35,528 - $70,585	151%
Triwest	$35,528	151%
Caremore	$36,239	154%
Imperial Nv	$37,304	159%
Universal Healthcare	$38,015	162%

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 $X.
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 Southern Hills Hospital and Medical Center 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.