Spinal fusion, single level (inpatient stay)
Facility: Oakleaf Surgical Hospital
Billing Code: 451 (MS-DRG)
- CPT Billing Code: 451
- Insurance Median: $22,877
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.97x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
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 | $22,877 | 97% |
| Dean Health Plan | $22,877 | 97% |
| Group Health Cooperative Of Eau Claire | $22,877 | 97% |
| Healthpartners | $22,877 | 97% |
| Humana | $22,877 | 97% |
| Medica | $22,877 | 97% |
| Quartz Health Solutions | $22,877 | 97% |
| Security Health Plan Of Wi | $22,877 | 97% |
| Ucare Wi | $22,877 | 97% |
| UnitedHealthcare | $22,877 | 97% |
Consumer Guidance & Cost Commentary
For this spinal fusion procedure at Oakleaf Surgical Hospital in Altoona, WI, the most significant benchmark available is the Medicare amount of $23,503.93, which serves as a scientifically validated baseline for the true cost of care. While the facility does not list a specific cash or negotiated rate in the provided data, it is important to note that commercial negotiated rates often exceed Medicare benchmarks due to administrative overhead and contract dynamics. In this specific case, the data indicates a median negotiated rate of $22,877 across ten payers, which is slightly lower than the Medicare amount. Patients should be aware that while cash-pay options can sometimes be cheaper for those with high-deductible plans, the absence of a listed cash price means they must directly inquire with the hospital about "self-pay" or "prompt-pay" discounts to determine if paying upfront could reduce their out-of-pocket costs.
When evaluating the financial impact of this procedure, consumers should avoid relying on summary bills or comparing rates against inflated chargemaster lists, as these practices can obscure the actual value of the service. Instead, patients are encouraged to request a detailed, itemized billing audit to ensure there are no errors, unbundled codes, or charges for services not rendered, as over 80% of hospital bills contain mistakes that can be corrected. Furthermore, if any balance billing occurs from out-of-network ancillary services, the No Surprises Act provides federal protections that prevent providers from charging patients for the difference between the allowed amount and the full chargemaster rate, making it critical to dispute any unexpected bills immediately rather than accepting them to avoid credit damage.