CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: St Peter's Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $32,836
Cash Discount Price: $48,499
vs. Medicare Baseline: 1.40x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at St Peter's Hospital is $32,836. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $48,499. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.40x the Medicare baseline. Located in 315 South Manning Boulevard, Albany, NY.

Cash / Self-Pay

$48,499

Average discount available for prompt cash payment at this facility.

Insurance Median

$32,836

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: $48,499 (206%)

Insurance Median: $32,836 (140%)

Cash: $48,499 (206% of Medicare)

Ins. Median: $32,836 (140% 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
Wellpath	$3,000	13%
Harvard Pilgrim Healthcare	$23,415	100%
UnitedHealthcare	$23,415 - $30,619	100%
Blue Cross Blue Shield	$29,441 - $30,042	125%
Medicare (plans)	$30,030 - $33,563	128%
Eddy Seniorcare Pace	$30,042	128%
Secure Horizons Ma Pffs	$30,619	130%
Aetna	$31,796 - $69,412	135%
Medicaid / KanCare	$31,844	135%
Hudson Headwaters Pace	$32,822	140%
Nascentia Health Plus	$33,647	143%
Fidelis Care	$54,075	230%
1199 National Benefit Fund	$69,412	295%
Allied Benefit Systems	$69,412	295%
Asr Health Benefits	$69,412	295%
Christian Brother Services	$69,412	295%
Geha	$69,412	295%
Lucent Health	$69,412	295%
Luminare Health	$69,412	295%
Medical Mutual	$69,412	295%
Meritain	$69,412	295%
Trustmark Small Business Benefits	$69,412	295%
Capital District Physicians Health Plan	$89,327	380%
Emblem Health	$89,779	382%
Nova	$89,779	382%

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 $48,499.
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 St Peter's 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.