CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Saint James Hospital

Billing Code: 451 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$25,941

about 1.1× the $23,504 Medicare rate · typically $25,689–$32,876

modeled estimate · not a bill or quote

What this hospital charges insurers

$25,647

About the fair price

about $294 under the fair price · 1.1× Medicare

Medicare pays $23,504 Fair price $25,941 This hospital $25,647

How we calculate the fair BaseRate →

How this hospital compares to other IL hospitals

Highest price of the 9 IL hospitals we have prices for — worth calling around.

Cheapest $20,475 Priciest $25,647

Black dot = this hospital, among the 9 IL hospitals with a price for this procedure. Full list below.

A fair price for a Spinal fusion, single level (inpatient stay) is about $25,941 (about 1.1× the $23,504 Medicare rate). Saint James Hospital charges insurers about $25,647 — about the fair price. Located in Pontiac, IL.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Humana CignaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$25,647	109%
Blue Cross Blue Shieldmajor	$25,901 - $34,640	110%
Aetnamajor	$25,647	109%
Humanamajor	$25,393	108%
Meridian	$25,393	108%
Molina	$25,393	108%
WellCare	$25,647	109%
+ 2 smaller / regional plans	$25,393 - $50,507

Government programs also on file: Military & VA.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price, before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the MS-DRG code on your bill matches exactly: 451.

Insurance Before you use insurance

Call your insurance company to confirm Saint James Hospital is in-network.
Ask your insurer whether prior approval is required for MS-DRG code 451.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Saint James Hospital

Compare: Spinal fusion, single level (inpatient stay) at other IL hospitals

Blessing Hospital · Quincy $20,475
Alexian Brothers Medical Center 1 · Elk Grove Village $22,126
St Alexius Medical Center · Hoffman Estates $22,507
Northwestern Medicine Delnor Community Hospital · Geneva $23,976
Edward Hospital · Naperville $24,728
Northwest Community Hospital 1 · Arlington Heights $24,748
OSF Saint Paul Medical Center · Mendota $25,070
Trinity Rock Island · Rock Island $25,085

Insurance negotiated median for the same procedure, sorted lowest first.