CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Valley Regional Medical Center

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $28,242
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.20x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Valley Regional Medical Center is $28,242. 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 1.20x the Medicare baseline. Located in 100 A Alton Gloor, Brownsville, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$28,242

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: $28,242 (120%)

Ins. Median: $28,242 (120% 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
United	$2,533 - $44,737	11%
Aetna	$16,222 - $34,918	69%
Humana	$26,442 - $78,198	113%
Cigna	$27,412 - $59,976	117%
Blue Cross Blue Shield	$27,688	118%
Texas Healthcare Foundation	$27,688	118%
Triwest Healthcare Alliance	$27,688	118%
Provider Partners Health Plan Of Texas	$28,242	120%
Wellmed	$28,242	120%
Physicians Health Choice	$28,519	121%
American Health Plan	$29,073	124%
Prominence Health	$29,073	124%
Superior Health Plan	$29,073	124%
Texas Independent Health Plan	$29,073	124%
Shared Health	$29,627	126%
Molina	$30,180	128%
Corvel Corporation	$39,199	167%
Omni Healthcare	$41,574	177%
Superior	$42,917	183%
Molina Healthcare	$43,501	185%
Curative Administrators	$44,088	188%
Independent Medical System	$45,016	192%
Oscar	$78,750	335%

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 $X.
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 Valley Regional Medical Center 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.