CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Melrosewakefield Healthcare

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $28,022
Cash Discount Price: $38,507
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Melrosewakefield Healthcare is $28,022. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $38,507. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.19x the Medicare baseline. Located in 585 Lebanon Street, Melrose, MA.

Cash / Self-Pay

$38,507

Average discount available for prompt cash payment at this facility.

Insurance Median

$28,022

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: $38,507 (164%)

Insurance Median: $28,022 (119%)

Cash: $38,507 (164% of Medicare)

Ins. Median: $28,022 (119% 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
Elementcare [450046]	$3,105	13%
Meritain [100063]	$3,984	17%
Fallon Senior [450065]	$26,216 - $28,022	112%
Champva [800006]	$28,022	119%
Cigna	$28,022	119%
Harvard Pilgrim Stride [450060]	$28,022	119%
Humana	$28,022	119%
Martins Point Generations Replacement [450057]	$28,022	119%
Medicaid / KanCare	$28,022 - $28,329	119%
Medicare (plans)	$28,022 - $28,565	119%
Neighborhood Pace [450114]	$28,022	119%
Peak Pace Solutions [450115]	$28,022	119%
Secure Horizons Ma Pffs [450077]	$28,022	119%
UnitedHealthcare	$28,022 - $28,329	119%
Veterans Evaluation Svcs [800004]	$28,022	119%
Veterans Services [800005]	$28,022	119%
Blue Cross Blue Shield	$28,329	121%
Commonwealth Care Alliance [450067]	$28,329	121%
Wellpoint [100139]	$34,420	146%
Fallon Health Connectorcare [100260]	$40,562	173%
Fallon Health [100259]	$40,562	173%

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 $38,507.
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 Melrosewakefield Healthcare 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.