CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Carilion Medical Center

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $96,675
Cash Discount Price: $54,575
vs. Medicare Baseline: 4.11x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Carilion Medical Center is $96,675. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $54,575. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 4.11x the Medicare baseline. Located in 1906 Belleview Avenue, Se, Roanoke, VA.

Cash / Self-Pay

$54,575

Average discount available for prompt cash payment at this facility.

Insurance Median

$96,675

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: $54,575 (232%)

Insurance Median: $96,675 (411%)

Cash: $54,575 (232% of Medicare)

Ins. Median: $96,675 (411% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 411% of the Medicare baseline (a markup of 311%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Humana	$19,977 - $28,138	85%
Aetna	$25,931 - $103,536	110%
Blue Cross Blue Shield	$28,138 - $102,371	120%
UnitedHealthcare	$28,414 - $127,455	121%
Sentara Health Plan	$28,966 - $96,675	123%
Vhn - Ultra	$96,675	411%
Cigna	$105,095 - $112,268	447%
Gateway - Tier 3	$106,031	451%
Connecticare	$109,149	464%
Vhn - Plus	$120,064	511%
Gateway - Tier 2	$124,742	531%
Vhn	$124,742	531%
Vhn - Link	$140,335	597%
Gateway - Tier 1	$148,131	630%
Vhn - Secondary Payors	$148,131	630%

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 $54,575.
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 Carilion 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.