CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Paoli Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 451
  • Insurance Median: $26,025
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.11x Medicare
The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Paoli Hospital is $26,025. 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 1.11x the Medicare baseline. Located in 255 West Lancaster Avenue, Paoli, PA.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$26,025

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: $26,025 (111%)
Ins. Median: $26,025 (111% 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
Blue Cross Blue Shield $23,659 - $60,094 101%
Mercy Life $23,659 101%
UnitedHealthcare $23,659 - $26,404 101%
Humana $24,132 103%
Keystone First $24,132 103%
Devoted Health $25,315 108%
Health Partners/Jefferson Health $25,433 108%
Aetna $25,788 - $82,828 110%
Pa Health & Wellness $26,025 111%
Provider Partners Health Plan $26,025 111%
Upmc $26,025 111%
Highmark Wholecare $26,262 112%
Geisinger Health $26,498 113%
Cigna $48,138 205%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 255 West Lancaster Avenue, Paoli, PA 19301
  • CMS Rating: ★★★★★
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals