CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: North Austin Medical Center

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 451
  • Insurance Median: $26,923
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.15x Medicare
The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at North Austin Medical Center is $26,923. 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 1.15x the Medicare baseline. Located in 12221 Mopac Expressway North, Austin, TX.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$26,923

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: $26,923 (115%)
Ins. Median: $26,923 (115% 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
Nomi Health $2,450 - $120,000 10%
Harbor Health Team $2,470 - $126,000 11%
United $2,781 - $59,970 12%
Aetna $3,463 - $28,243 15%
Cigna $5,963 - $26,923 25%
Altus Hospice (Hospice Of The Hills) $23,755 101%
Cella Bella Hospice $23,755 101%
Compassionate Care Mcr $23,755 101%
Heart To Heart Hospice $23,755 101%
Hospice Austin $23,755 101%
Hospice Compassus $23,755 101%
Silverado Hospice $23,755 101%
St David’S Hospice $23,755 101%
Moda $24,086 102%
Wellmed $26,052 111%
Angel Heart Hospice $26,395 112%
Aseracare Hospice $26,395 112%
Blue Cross Blue Shield $26,395 112%
Girling Hospice $26,395 112%
Lighthouse Hospice, Llc. $26,395 112%
Odyssey Hospice $26,395 112%
Southern Care Hospice $26,395 112%
Texas Home Health Hospice $26,395 112%
Triwest Healthcare Alliance $26,395 112%
UnitedHealthcare $26,395 112%
Vistacare Family Hospice $26,395 112%
Wesleyan Homes, Inc. $26,395 112%
Devoted Health $26,923 115%
Provider Partners Health Plan $26,923 115%
American Health Plan Of Texas $27,715 - $29,034 118%
Superior Health Plan $27,715 - $42,232 118%
Universal Health $27,715 118%
Imperial Insurance $27,979 119%
Humana $28,243 120%
Shared Health $28,243 120%
Oscar $28,473 - $31,637 121%
Molina Healthcare $28,770 122%
Pyramid Life $29,034 124%
Texas Independent Health Plan $29,298 125%
Wellcare $29,298 125%
Austin Fc $32,994 140%
Sendero $35,633 - $45,135 152%
Corvel Corporation $37,367 159%
Healthcare Highways $40,561 - $41,385 173%
Naphcare $40,912 174%
Seven Corners $40,912 174%
Moda Health $43,723 - $44,599 186%
Curative Administrators $44,088 188%
Evry Health $44,502 189%
Covenant Management Systems $53,411 227%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 12221 Mopac Expressway North, Austin, TX 78758
  • CMS Rating: ★★★☆☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals