CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Children's Hospital of San Antonio

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $2,623
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.11x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Children's Hospital of San Antonio is $2,623. 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 0.11x the Medicare baseline. Located in 333 N Santa Rosa St, San Antonio, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,623

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: $2,623 (11%)

Ins. Median: $2,623 (11% 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
Christus Health	$2,420 - $3,566	10%
Blue Cross Blue Shield	$2,457	10%
Aetna	$2,547	11%
Allwell	$2,547	11%
Community First	$2,547	11%
Humana	$2,547 - $53,882	11%
Molina	$2,547	11%
Superior	$2,547	11%
Texas Healthspring	$2,547	11%
Triwest	$2,547	11%
UnitedHealthcare	$2,547	11%
Wellcare	$2,547	11%
Provider Partners Health Plan	$2,623	11%
Texas Independence Health Plan	$2,623	11%
Shared Health Insurance Company	$2,674	11%
Us Imaging Network	$2,725	12%
Amerigroup	$2,751	12%
Devoted Health Plan	$2,751	12%
Imperial Health Plan	$2,802	12%
Medicare (plans)	$2,802	12%
Procare Advantage	$2,802	12%
Gilsbar Inc.	$3,311	14%
Coventry	$3,995	17%
Five Point Credit Union	$4,190 - $10,056	18%
Naphcare Inc.	$5,858	25%

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 Children's Hospital of San Antonio 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.