CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Methodist McKinney Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $27,823
Cash Discount Price: $54,601
vs. Medicare Baseline: 1.18x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Methodist McKinney Hospital is $27,823. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $54,601. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.18x the Medicare baseline. Located in 8000 W Eldorado Pkwy Bldg C Suite C, McKinney, TX.

Cash / Self-Pay

$54,601

Average discount available for prompt cash payment at this facility.

Insurance Median

$27,823

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%)

Cash / Self-Pay: $54,601 (232%)

Insurance Median: $27,823 (118%)

Cash: $54,601 (232% of Medicare)

Ins. Median: $27,823 (118% 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
Aetna	$22,258 - $53,890	95%
Blue Cross Blue Shield	$22,258 - $23,594	95%
Medicare (plans)	$22,258 - $23,817	95%
UnitedHealthcare	$22,258 - $23,594	95%
Ust Health Proof [1005]	$22,258	95%
Wellcare [7016]	$22,258	95%
American Health Advantage Of Texas [7099]	$23,371	99%
Cigna	$23,371 - $35,489	99%
Globalhealth [1003]	$23,371	99%
Procare Advantage [7018]	$23,371	99%
Humana	$23,594	100%
Southwestern Health Resources Swhr [7015]	$23,594	100%
Provider Partners Health Plan [7025]	$24,484	104%
Mcs Advantage, Inc Classicare [7021]	$25,152	107%
Medical Card System [2063]	$25,152	107%
Alternative Service Concepts [8005]	$27,823	118%
Champva [1000]	$31,029	132%
Tricare	$31,029	132%
Triwest Wps [8010]	$31,029	132%
Veterans Administration [9001]	$31,029	132%
Oscar Insurance Company [2057]	$31,162	133%
Bright Healthcare [2222]	$31,918	136%
Molina [3017]	$32,275	137%
Sana Benefits [3069]	$33,388	142%
Wellpoint Marketplace Exchange [3071]	$34,501	147%
Web Tpa [3049]	$35,489 - $53,890	151%
90 Degree Benefit [3057]	$36,727	156%
Allied National [2031]	$36,727	156%
Entrust/90 Degree [2058]	$36,727	156%
Friday Health Plan [2061]	$37,839	161%
Ambetter / Centene	$38,062	162%
Imperial Insurance Companies [3073]	$40,065	170%
Evry Health [1013]	$55,646	237%
Velocity [3070]	$55,646	237%

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 $54,601.
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 Methodist McKinney Hospital 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.