CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Houston Methodist the Woodlands Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $25,085
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Houston Methodist the Woodlands Hospital is $25,085. 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 1.07x the Medicare baseline. Located in 17201 Interstate 45 South, The Woodlands, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$25,085

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: $25,085 (107%)

Ins. Median: $25,085 (107% 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
Blue Cross Blue Shield	$23,444	100%
Humana	$23,444	100%
Texas Monarch	$23,444	100%
Triwest Healthcare	$23,444	100%
UnitedHealthcare	$23,444 - $45,716	100%
Aetna	$23,796	101%
Cigna	$24,147 - $40,914	103%
Wellpoint	$24,147	103%
Molina Healthcare	$24,616 - $46,888	105%
Oscar	$24,616	105%
Community Health Choice	$25,085 - $44,543	107%
Devoted Health	$25,085 - $29,305	107%
Texas Annual Conference	$38,214 - $44,543	163%
Entrust	$46,734	199%
Advanced Medical Pricing Solutions	$46,888	199%

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 Houston Methodist the Woodlands 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.