CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Cannon Memorial Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $18,691
Cash Discount Price: $141,702
vs. Medicare Baseline: 0.80x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Cannon Memorial Hospital is $18,691. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $141,702. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 0.80x the Medicare baseline. Located in 123 W G Acker Drive, Pickens, SC.

Cash / Self-Pay

$141,702

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,691

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: $141,702 (603%)

Insurance Median: $18,691 (80%)

Cash: $141,702 (603% of Medicare)

Ins. Median: $18,691 (80% 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
Cigna	$18,320	78%
Nhc Advantage Alt Payer [6101]	$18,320	78%
Nhc Advantage [61]	$18,320	78%
UnitedHealthcare	$18,320 - $18,691	78%
Absolute Total Care Mcr Plans Alt Payer [4101]	$18,691	80%
Absolute Total Care Mcr Plans [41]	$18,691	80%
Aetna	$18,691	80%
Ambetter / Centene	$18,691	80%
Blue Cross Blue Shield	$18,691 - $83,226	80%
Bright Health Alt Payer [1001]	$18,691	80%
Champva [604]	$18,691	80%
Continental Life Ins Co [7]	$18,691	80%
Devoted Health Alt Payer [9401]	$18,691	80%
Devoted Health [94]	$18,691	80%
Edison Health Solutions [95]	$18,691	80%
First Choice Next [96]	$18,691	80%
First Choice Vip Careplus Alt Payer [3301]	$18,691	80%
First Choice Vip [33]	$18,691	80%
Healthscope [98]	$18,691	80%
Humana	$18,691	80%
Medicare (plans)	$18,691	80%
Molina Dual Options [15]	$18,691	80%
Molina Marketplace [97]	$18,691	80%
Mutual Of Omaha [107]	$18,691	80%
Tricare	$18,691	80%
Vaccn - Va Community Care Network [16]	$18,691	80%
Veterans Administration [633]	$18,691	80%
Workers Compensation [622]	$18,691	80%
Bright Health [11]	$46,290	197%

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 $141,702.
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 Cannon Memorial 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.