CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Community Memorial Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $59,149
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.52x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Community Memorial Hospital is $59,149. 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 2.52x the Medicare baseline. Located in W180 N8085 Town Hall Rd, Menomonee Falls, WI.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$59,149

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: $59,149 (252%)

Ins. Median: $59,149 (252% 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 252% of the Medicare baseline (a markup of 152%). 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
Allwell	$25,566	109%
Blue Cross Blue Shield	$25,566 - $101,044	109%
Community Care	$25,566	109%
Health Partners	$25,566 - $65,816	109%
Humana	$25,566	109%
Icare	$25,566	109%
Network Health Plan	$25,566 - $60,570	109%
Security Health Plan	$25,566	109%
UnitedHealthcare	$25,566 - $95,181	109%
Aetna	$26,077	111%
Care Wisconsin/Mychoice	$26,333	112%
Chorus Community Health Plan	$59,149	252%
Froedtert South	$59,514	253%
Sheboygan Employers Health Network	$59,811	254%
Centivo	$60,218 - $72,878	256%
Wisconsin Physician Services	$74,768	318%
Cigna	$88,109	375%

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 Community Memorial 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.