CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Charleston Area Medical Center

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $56,739
Cash Discount Price: $231,226
vs. Medicare Baseline: 2.41x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Charleston Area Medical Center is $56,739. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $231,226. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 2.41x the Medicare baseline. Located in 501 Morris Street, Charleston, WV.

Cash / Self-Pay

$231,226

Average discount available for prompt cash payment at this facility.

Insurance Median

$56,739

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: $231,226 (984%)

Insurance Median: $56,739 (241%)

Cash: $231,226 (984% of Medicare)

Ins. Median: $56,739 (241% 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 241% of the Medicare baseline (a markup of 141%). 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
Aetna	$18,237 - $226,601	78%
The Health Plan Of West Virginia Inc.	$18,237 - $224,289	78%
Unicare Health Plan Of West Virginia Inc.	$18,237	78%
Triwest Va	$19,656	84%
Blue Cross Blue Shield	$20,264 - $210,855	86%
Choicecare Network	$20,264 - $226,601	86%
Optimum Choice Inc.	$20,264	86%
UnitedHealthcare	$20,872 - $226,601	89%
West Virginia Senior Advantage Inc.	$21,277	91%
Integrated Medical Solutions	$29,383	125%
Naphcare	$40,528	172%
Caresource	$56,739	241%
Tricare	$138,735	590%
City Of Charleston	$173,419	738%
Cigna	$215,040	915%
Three Rivers Providers Network	$224,289	954%
Healthsmart	$226,601	964%
Multiplan	$226,601	964%

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 $231,226.
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 Charleston Area 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.