Spinal fusion, single level (inpatient stay)
Facility: Wamego Health Center
Billing Code: 451 (MS-DRG)
- CPT Billing Code: 451
- Insurance Median: $14,493
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.62x 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 |
|---|---|---|
| UnitedHealthcare | $13,936 | 59% |
| Aetna | $14,493 | 62% |
| Medicaid / KanCare | $14,493 - $14,632 | 62% |
Consumer Guidance & Cost Commentary
For the procedure "Spinal fusion, single level (inpatient stay)" at Wamego Health Center in Wamego, KS, the facility's negotiated rates with major payers like UnitedHealthcare and Aetna average $14,493, which is significantly lower than the Medicare benchmark of $23,503.93. This indicates that the facility is charging well below the federal government's calculated cost baseline for this service. While Medicaid/KanCare plans show a slightly higher range of $14,493 to $14,632, the consistent drop from the Medicare amount suggests that commercial contracts are providing substantial savings compared to the standard federal reimbursement rate.
Patients should be aware that while insurance offers protection against balance billing for in-network care, the actual cost to the patient depends heavily on their specific plan's deductible and copay structure. If you have a high-deductible plan, paying the cash price directly might be more affordable than the insurance negotiated rate, as the insurer's allowed amount often exceeds the cash price. To maximize savings, you should contact the hospital before scheduling to request a "self-pay" or "prompt-pay" discount, which can reduce the bill by 20% to 50% if paid in full upfront. Always ask to waive automatic insurance submission to ensure you receive the cash discount rather than being billed the higher negotiated rate.