CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Methodist Hospitals Inc

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $43,692
Cash Discount Price: $112,701
vs. Medicare Baseline: 1.86x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Methodist Hospitals Inc is $43,692. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $112,701. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.86x the Medicare baseline. Located in 600 Grant St, Gary, IN.

Cash / Self-Pay

$112,701

Average discount available for prompt cash payment at this facility.

Insurance Median

$43,692

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: $112,701 (479%)

Insurance Median: $43,692 (186%)

Cash: $112,701 (479% of Medicare)

Ins. Median: $43,692 (186% 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
Aetna	$26,044 - $96,280	111%
Blue Cross Blue Shield	$26,044 - $49,832	111%
Humana	$26,044	111%
Medicare (plans)	$26,044	111%
United Heathcare	$26,044	111%
Zing	$26,565	113%
Caresource Maketplace	$42,972	183%
UnitedHealthcare	$44,412 - $47,752	189%
Ambetter / Centene	$52,087	222%
Siho	$108,353	461%
Magnacare	$120,171	511%

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 $112,701.
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 Methodist Hospitals Inc 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.