CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: North Carolina Baptist Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $33,995
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at North Carolina Baptist Hospital is $33,995. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.45x the Medicare baseline. Located in Medical Center Boulevard, Winston-Salem, NC.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$33,995

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%)

Insurance Median: $33,995 (145%)

Ins. Median: $33,995 (145% 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
Amerihealth	$30,203 - $31,135	129%
Carolina Complete	$30,203	129%
Health Blue	$30,203	129%
Partners	$30,203	129%
Vaya	$30,505	130%
UnitedHealthcare	$30,507 - $46,836	130%
Wellcare	$30,507 - $33,995	130%
Alliance	$30,807	131%
Blue Cross Blue Shield	$31,030 - $49,827	132%
Trillium	$31,109	132%
Ambetter / Centene	$32,246	137%
Aetna	$33,995	145%
Apex	$33,995	145%
Cigna	$33,995 - $49,778	145%
Devoted	$33,995	145%
Healthteam	$33,995	145%
Humana	$34,335	146%
Medicare (plans)	$34,335	146%
Liberty	$39,094	166%

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 $X.
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 North Carolina Baptist Hospital 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.