CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Jefferson Lansdale Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $25,371
Cash Discount Price: $25,856
vs. Medicare Baseline: 1.08x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Jefferson Lansdale Hospital is $25,371. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $25,856. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.08x the Medicare baseline. Located in 100 Medical Campus Drive, Lansdale, PA.

Cash / Self-Pay

$25,856

Average discount available for prompt cash payment at this facility.

Insurance Median

$25,371

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: $25,856 (110%)

Insurance Median: $25,371 (108%)

Cash: $25,856 (110% of Medicare)

Ins. Median: $25,371 (108% 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
Medicare (plans)	$21,604 - $26,524	92%
Jefferson Health Plan Aca Qhp Exchange	$22,186	94%
Inspira Life	$23,064	98%
Point Of Comfort Refugee Resettlement	$23,064	98%
Provider Partners Health Plan	$23,064	98%
Tricare	$23,064	98%
UnitedHealthcare	$23,064 - $46,505	98%
Humana	$23,525	100%
Innovage	$23,525	100%
Cigna	$23,987 - $60,492	102%
Devoted Health Participation	$24,217	103%
Aetna	$24,448 - $51,206	104%
Keystone First Vip Choice	$24,448	104%
Allwell Pa Health_Wellness Ma	$25,371	108%
Highmark Wholecare Gateway	$25,371	108%
St Agnes	$25,799	110%
Perennial	$26,754	114%
Ibc Employee Benefit	$28,830	123%
Ibc Main Line Health	$28,830	123%
Ambetter / Centene	$34,577	147%
Naphcare	$36,903	157%
Highmark	$39,106 - $48,454	166%
Blue Cross Blue Shield	$43,791 - $47,161	186%
Upmc Commercial	$60,492	257%
Geisinger Health Plan	$96,734	412%

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 $25,856.
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 Jefferson Lansdale 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.