CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Mercy Health Saint Mary's

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $41,008
Cash Discount Price: $57,469
vs. Medicare Baseline: 1.74x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Mercy Health Saint Mary's is $41,008. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $57,469. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.74x the Medicare baseline. Located in 200 Jefferson Avenue Se, Grand Rapids, MI.

Cash / Self-Pay

$57,469

Average discount available for prompt cash payment at this facility.

Insurance Median

$41,008

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: $57,469 (245%)

Insurance Median: $41,008 (174%)

Cash: $57,469 (245% of Medicare)

Ins. Median: $41,008 (174% 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
Access Health	$17,741	75%
Aetna	$24,837 - $53,231	106%
Blue Care Network Advantage	$24,837	106%
Blue Cross Blue Shield	$24,837 - $63,580	106%
Medicare (plans)	$24,837	106%
Align Senior Care	$25,344	108%
Correctional Recovery	$25,344	108%
UnitedHealthcare	$26,104	111%
Longevity Ipa Of Michigan Llc Health Plan Isnp	$28,563	122%
Oscar	$29,087	124%
Molina Marketplace	$32,947	140%
Caresource	$36,704	156%
Hap	$36,704	156%
U Of M Health Plan	$45,313	193%
Geha	$53,231	226%
Medical Mutual	$53,231	226%
Meritain	$53,231	226%
Preferred One	$53,231	226%
Bcn Domestic	$63,580	271%
Blue Benefit Administrators Of Massachusetts	$63,580	271%
Blue Care Network	$63,580	271%
Blue Distinction Transplant	$63,580	271%
Blue Shield - Ca	$63,580	271%
Blue Shield - Id (Regence)	$63,580	271%
Blue Shield - Ny Highmark Northeastern	$63,580	271%
Blue Shield - Ny Highmark Western	$63,580	271%
Blue Shield - Pa (Highmark)	$63,580	271%
Blue Shield - Wa (Regence)	$63,580	271%
Health Choices	$63,580	271%
Kaiser Domestic	$63,580	271%

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 $57,469.
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 Mercy Health Saint Mary's 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.