CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Sanford Usd Medical Center

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 451
  • Insurance Median: $28,421
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.21x Medicare
The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Sanford Usd Medical Center is $28,421. 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 1.21x the Medicare baseline. Located in 1305 W 18Th St Post Office Box 5039, Sioux Falls, SD.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$28,421

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: $28,421 (121%)
Ins. Median: $28,421 (121% 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
Health Partners $23,677 - $33,777 101%
Sanford Health Plan Align $25,715 109%
Ucare $27,609 117%
Aetna $27,880 119%
Blue Cross Blue Shield $27,880 119%
Medicare (plans) $27,880 119%
UnitedHealthcare $27,880 - $55,983 119%
Primewest $28,421 121%
Sanford Health Plan $31,475 - $42,222 134%
Medica $52,542 - $56,222 224%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1305 W 18Th St Post Office Box 5039, Sioux Falls, SD 57117
  • CMS Rating: ★★★★★
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals