CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: St Charles Medical Center Prineville

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $5,349
Cash Discount Price: $118,609
vs. Medicare Baseline: 0.23x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at St Charles Medical Center Prineville is $5,349. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $118,609. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 0.23x the Medicare baseline. Located in 384 Se Combs Flat Road, Prineville, OR.

Cash / Self-Pay

$118,609

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,349

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: $118,609 (505%)

Insurance Median: $5,349 (23%)

Cash: $118,609 (505% of Medicare)

Ins. Median: $5,349 (23% 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
Aetna	$5,349	23%
Ageright Advantage [142]	$5,349	23%
Champ Va [700]	$5,349	23%
Cigna	$5,349	23%
Covid19 Hrsa Uninsured Testing And Treatment Fund	$5,349	23%
Devoted Health Inc [145]	$5,349	23%
Health Market Care Assured [134]	$5,349	23%
Health Net Med Adv [135]	$5,349	23%
Humana	$5,349	23%
Indian Health [704]	$5,349	23%
Kaiser Permanente Med Adv [136]	$5,349	23%
Law Enforcement [701]	$5,349	23%
Medicare (plans)	$5,349 - $6,205	23%
Samaritan Health Plan Med Adv [141]	$5,349	23%
Unicare [133]	$5,349	23%
UnitedHealthcare	$5,349	23%
Veterans [706]	$5,349	23%
Wellcare [132]	$5,349	23%
Blue Cross Blue Shield	$5,884	25%
Pacificsource Community Solutions [525]	$21,400 - $23,721	91%
Otj Dept Of Labor Federal Emp [652]	$27,664	118%
Otj Us Department Of Labor [669]	$27,664	118%
Kaiser Permanente [334]	$51,179	218%
Moda [310]	$55,329	235%
Providence Health Plan [347]	$55,329	235%

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 $118,609.
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 Charles Medical Center Prineville 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.