CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Prisma Health Baptist

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $26,823
Cash Discount Price: $93,818
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Prisma Health Baptist is $26,823. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $93,818. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.14x the Medicare baseline. Located in 1330 Taylor at Marion St, Columbia, SC.

Cash / Self-Pay

$93,818

Average discount available for prompt cash payment at this facility.

Insurance Median

$26,823

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: $93,818 (399%)

Insurance Median: $26,823 (114%)

Cash: $93,818 (399% of Medicare)

Ins. Median: $26,823 (114% 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	$25,545 - $118,770	109%
Cigna	$25,545 - $77,927	109%
Humana	$25,545	109%
Medicare (plans)	$25,545 - $26,823	109%
Ambetter / Centene	$25,610	109%
Covid19 Hrsa Uninsured Testing & Treatment Fund [904]	$25,610	109%
Triwest Healthcare Alliance Vcp [902]	$25,610	109%
Va Community Care Network-Vaccn [903]	$25,610	109%
UnitedHealthcare	$26,439 - $102,765	112%
Aetna	$26,823	114%
Healthy Conn Prime-First Choice Vip Care [5300]	$26,823	114%
Healthy Conn Prime-Molina Healthcare [5330]	$26,823	114%
Healthy Conn Prime-Wellcare Prime By Atc [5310]	$26,823	114%
Workers Comp [600]	$35,763	152%
Scdc-Sc Dept Of Corrections [7232]	$55,641	237%
Preferred Administrators Contracted [2839]	$57,365	244%
Promise Health Plan Contracted [2401]	$62,993	268%
Evernorth Behavioral Contracted [2982]	$77,927	332%
Bluechoice [810]	$92,038 - $119,046	392%
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]	$118,770	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 $93,818.
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 Baptist 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.