CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Memorialcare Orange Coast Medical Center

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $39,415
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.68x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Memorialcare Orange Coast Medical Center is $39,415. 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 1.68x the Medicare baseline. Located in 9920 Talbert Avenue, Fountain Valley, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$39,415

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: $39,415 (168%)

Ins. Median: $39,415 (168% 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
Monarch Health Plan	$30,373 - $68,420	129%
Blue Shield	$31,332	133%
Blue Cross Blue Shield	$31,972 - $72,763	136%
Citizens Choice	$31,972	136%
Healthcare Partners	$31,972 - $78,970	136%
Healthnet	$31,972 - $84,381	136%
Heritage Provider Network	$31,972	136%
Humana	$31,972	136%
La Care	$31,972	136%
Onecare	$31,972	136%
UnitedHealthcare	$31,972 - $90,031	136%
Wellcare	$31,972	136%
Molina	$32,931	140%
Clever Care	$33,570	143%
Universal Care	$33,570	143%
Central Health	$35,169	150%
Select Health	$43,162	184%
Aetna	$44,676 - $87,979	190%
Cigna	$60,929 - $95,777	259%
Centivo	$71,937	306%

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 Memorialcare Orange Coast 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.