CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Prisma Health Richland Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $29,039
Cash Discount Price: $115,714
vs. Medicare Baseline: 1.24x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Prisma Health Richland Hospital is $29,039. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $115,714. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.24x the Medicare baseline. Located in 5 Medical Park, Columbia, SC.

Cash / Self-Pay

$115,714

Average discount available for prompt cash payment at this facility.

Insurance Median

$29,039

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: $115,714 (492%)

Insurance Median: $29,039 (124%)

Cash: $115,714 (492% of Medicare)

Ins. Median: $29,039 (124% 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
Blue Cross Blue Shield	$25,922 - $118,714	110%
Cigna	$25,922 - $77,927	110%
Humana	$25,922	110%
Medicare (plans)	$25,922 - $29,039	110%
UnitedHealthcare	$26,829 - $102,765	114%
Aetna	$27,218	116%
Healthy Conn Prime-First Choice Vip Care [5300]	$27,218	116%
Healthy Conn Prime-Molina Healthcare [5330]	$27,218	116%
Healthy Conn Prime-Wellcare Prime By Atc [5310]	$27,218	116%
Ambetter / Centene	$29,039	124%
Covid19 Hrsa Uninsured Testing & Treatment Fund [904]	$29,039	124%
Triwest Healthcare Alliance Vcp [902]	$29,039	124%
Va Community Care Network-Vaccn [903]	$29,039	124%
Workers Comp [600]	$36,291	154%
Sc Dept Of Corrections [2998]	$65,535	279%
Scdc-Sc Dept Of Corrections [7232]	$65,535	279%
Evernorth Behavioral Contracted [2982]	$77,927	332%
Bluechoice [810]	$90,718 - $108,201	386%
Golden Rule Insurance Company [2991]	$102,765	437%
Oxford Health Plans [2992]	$102,765	437%
Zzumr-Salt Lake City Ut [3169]	$102,765	437%
Planned Administrators [820]	$118,714	505%

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 $115,714.
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 Prisma Health Richland 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.