CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Saint Thomas Highlands Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 451
  • Insurance Median: $16,559
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 0.70x Medicare
The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Saint Thomas Highlands Hospital is $16,559. 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 0.70x the Medicare baseline. Located in 401 Sewell Dr, Sparta, TN.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$16,559

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: $16,559 (70%)
Ins. Median: $16,559 (70% 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
Oscar Health $8,394 - $9,510 36%
Cigna $9,564 - $16,559 41%
Smart Health $10,594 - $33,985 45%
UnitedHealthcare $11,485 - $24,275 49%
Blue Cross Blue Shield $15,440 - $59,628 66%
Aetna $19,970 - $24,761 85%
Point Comfort Underwriters $21,848 93%
Amerigroup Mcr Replacement $24,275 103%
Ascension Complete $24,275 103%
Centurion Of Tn $24,275 103%
Covid Uninsured Test Fund $24,275 103%
Healthspring Mcr Replacement $24,275 103%
Humana $24,275 103%
Medicare (plans) $24,275 103%
Nhc Advantage $24,275 103%
Ambetter / Centene $31,558 134%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 401 Sewell Dr, Sparta, TN 38583
  • CMS Rating: No CMS Rating
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals