CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Garnet Health Medical Center

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 451
  • Insurance Median: $34,442
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.47x Medicare
The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Garnet Health Medical Center is $34,442. 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 1.47x the Medicare baseline. Located in 707 East Main Street, Middletown, NY.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$34,442

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: $34,442 (147%)
Ins. Median: $34,442 (147% 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.

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
Aetna $34,442 - $96,912 147%
Blue Cross Blue Shield $34,442 147%
Cdphp $34,442 - $119,250 147%
Cigna $34,442 - $97,587 147%
Emblem Health $34,442 - $118,352 147%
Geisinger Health Plan $34,442 - $77,495 147%
Health First $34,442 147%
Humana $34,442 147%
Mvp $34,442 147%
Prime Health Services $34,442 147%
UnitedHealthcare $34,442 - $100,375 147%
Upmc $34,442 147%
Wellcare $34,959 149%
Fidelis $35,131 149%
Northwell Direct $71,069 302%
Local 1199 $96,912 412%
Magnacare $124,984 532%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 707 East Main Street, Middletown, NY 10940
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals