CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: St Charles Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 451
  • Insurance Median: $28,601
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.22x Medicare
The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at St Charles Hospital is $28,601. 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 1.22x the Medicare baseline. Located in 200 Belle Terre Road, Port Jefferson, NY.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$28,601

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: $28,601 (122%)
Ins. Median: $28,601 (122% 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
Brighton $6,454 - $9,258 27%
Apwu $18,030 77%
Centivo $18,030 - $47,046 77%
Cigna $18,030 77%
Daniel H Cook $18,030 77%
Mvp Health Plans $18,030 - $28,601 77%
Nalc $18,030 77%
Samba $18,030 77%
Us Family Health Plan $27,555 117%
Blue Cross Blue Shield $28,029 - $71,629 119%
Centerlight Healthcare $28,029 119%
Emblem Health $28,558 - $70,602 122%
Beacon Health Options $28,601 - $40,041 122%
Beacon Health Strategies $28,601 - $40,041 122%
Centers Plan For Healthy Living $28,601 122%
Elderplan Inc. $28,601 122%
Fidelis Care New York $28,601 122%
Healthspring $28,601 122%
Independent Health $28,601 122%
Liberty Health $28,601 122%
Longevity Health Plan $28,601 122%
Medicare (plans) $28,601 - $30,031 122%
Orthonet - Uniformed Services Family Health Plan $28,601 122%
Pmc $28,601 122%
Senior Whole Health $28,601 122%
Tricare $28,601 122%
UnitedHealthcare $28,601 - $71,629 122%
Universal Healthcare $28,601 122%
Veterans Affairs $28,601 122%
Zadroga $28,601 122%
Aetna $28,842 - $64,269 123%
Health Plus $28,842 123%
Health First $28,887 - $64,352 123%
Humana $29,173 124%
Agewell New York $29,602 126%
Wellcare Health Plan Inc $29,745 127%
Partners Health Plan $30,031 128%
Local 1199 $49,398 210%
Mail Handlers Benefit Plan $64,269 273%
Meritain Health $64,269 273%
Nippon Life Insurance Company Of America $64,269 273%
Salvation Army $64,269 273%
American Plan Administrators $70,602 300%
Amerihealth Administrators $70,602 300%
Benefit Services $70,602 300%
Ghi Cbp Ny City Employee Alternate $70,602 300%
International Benefit Administrator $70,602 300%
Ultra Benefits Inc. $70,602 300%
Surest $71,518 304%
Self Pay $71,629 305%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 200 Belle Terre Road, Port Jefferson, NY 11777
  • CMS Rating: ★★★★★
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals