CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Piedmont Fayette Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $46,901
Cash Discount Price: $50,565
vs. Medicare Baseline: 2.00x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Piedmont Fayette Hospital is $46,901. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $50,565. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 2.00x the Medicare baseline. Located in 1255 Highway 54 West, Fayetteville, GA.

Cash / Self-Pay

$50,565

Average discount available for prompt cash payment at this facility.

Insurance Median

$46,901

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: $50,565 (215%)

Insurance Median: $46,901 (200%)

Cash: $50,565 (215% of Medicare)

Ins. Median: $46,901 (200% 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
Phcs [10601]	$7,561	32%
Medicare (plans)	$25,859 - $26,864	110%
UnitedHealthcare	$26,236 - $72,338	112%
Clear Spring Health Care [30192]	$26,612	113%
Georgia Health Advantage [30143]	$26,864	114%
Ambetter / Centene	$46,784	199%
Aetna	$48,046	204%
Cigna	$49,086 - $76,176	209%
Alliant Solocare [11101]	$51,121	217%
Caresource Marketplace [11106]	$53,978	230%
Alliant Health Plans Of Georgia [10952]	$64,127	273%
Blue Cross Blue Shield	$80,562 - $90,010	343%

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 $50,565.
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 Piedmont Fayette 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.