CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Tufts Medical Center

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $30,711
Cash Discount Price: $37,816
vs. Medicare Baseline: 1.31x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Tufts Medical Center is $30,711. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $37,816. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.31x the Medicare baseline. Located in 800 Washington Street, Boston, MA.

Cash / Self-Pay

$37,816

Average discount available for prompt cash payment at this facility.

Insurance Median

$30,711

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: $37,816 (161%)

Insurance Median: $30,711 (131%)

Cash: $37,816 (161% of Medicare)

Ins. Median: $30,711 (131% 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
UnitedHealthcare	$4,284 - $39,916	18%
Health Safety Net [500011]	$7,050	30%
Elementcare [450046]	$12,343	53%
Fallon Senior [450065]	$27,840 - $30,128	118%
Cigna	$30,128 - $65,280	128%
Harvard Pilgrim Stride [450060]	$30,128	128%
Humana	$30,128	128%
Martins Point Generations Replacement [450057]	$30,128	128%
Medicare (plans)	$30,128 - $39,916	128%
Neighborhood Pace [450114]	$30,128	128%
Peak Pace Solutions [450115]	$30,128	128%
Secure Horizons Ma Pffs [450077]	$30,128	128%
Aetna	$30,711 - $52,698	131%
Blue Cross Blue Shield	$30,711	131%
Commonwealth Care Alliance [450067]	$30,711	131%
Medicaid / KanCare	$30,711 - $39,916	131%
Veterans Evaluation Svcs [800004]	$39,158	167%
Champva [800006]	$39,916	170%
Veterans Services [800005]	$39,916	170%
Meritain [100063]	$40,887	174%
Wellpoint [100139]	$67,021	285%
Fallon Health Connectorcare [100260]	$72,248	307%
Fallon Health [100259]	$72,248	307%

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 $37,816.
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 Tufts 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.