CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Good Samaritan Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $35,735
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.52x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Good Samaritan Hospital is $35,735. 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 1.52x the Medicare baseline. Located in 2425 Samaritan Drive, San Jose, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$35,735

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: $35,735 (152%)

Ins. Median: $35,735 (152% 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.

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
First Health	$3,183 - $5,426	14%
Healthsmart	$3,789	16%
Multiplan	$4,183	18%
Health Net	$4,316 - $8,580	18%
Cigna	$6,671 - $39,539	28%
Aetna	$8,355 - $96,289	36%
United	$10,135 - $37,191	43%
Vitas Healthcare Hospice	$32,162	137%
Vitality Health Plan	$34,663	147%
Affinity Medical Group	$35,735	152%
Alignment Health Plan	$35,735	152%
Blue Cross Blue Shield	$35,735	152%
Central Health Plan	$35,735	152%
Clever Care Of Golden State	$35,735 - $37,522	152%
Easy Choice Health Plan	$35,735	152%
Humana	$35,735	152%
Medcare Partners	$35,735 - $37,522	152%
On Lok Senior Health	$35,735	152%
Palo Alto Medical	$35,735 - $46,456	152%
Santa Clara Family Health Plan	$35,735	152%
Scan Health Plan	$35,735	152%
Triwest Healthcare Alliance	$35,735	152%
University Healthcare	$35,735	152%
Blue Shield	$36,450	155%
Care1St Health Plan	$36,450	155%
Affinity Medical Group Comm	$46,456	198%
Corvel Corporation	$51,892	221%

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 Good Samaritan 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.