CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Mount Carmel East & West

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $60,127
Cash Discount Price: $138,404
vs. Medicare Baseline: 2.56x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Mount Carmel East & West is $60,127. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $138,404. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 2.56x the Medicare baseline. Located in 6001 East Broad Street, Columbus, OH.

Cash / Self-Pay

$138,404

Average discount available for prompt cash payment at this facility.

Insurance Median

$60,127

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: $138,404 (589%)

Insurance Median: $60,127 (256%)

Cash: $138,404 (589% of Medicare)

Ins. Median: $60,127 (256% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 256% of the Medicare baseline (a markup of 156%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Aetna	$22,705 - $43,440	97%
Blue Cross Blue Shield	$22,705 - $86,565	97%
Medicare (plans)	$22,705 - $24,327	97%
UnitedHealthcare	$23,159 - $68,061	99%
The Health Plan	$23,631	101%
Oscar	$36,474	155%
Enterprise Group Planning	$44,714	190%
Custom Design Benefits	$48,421	206%
Quality Care Partners	$52,360	223%
Medical Mutual	$52,639 - $73,110	224%
American Postal Workers Secondary	$67,615	288%
Cigna	$67,615	288%
Health Partners	$67,615	288%
Healthgram	$67,615	288%
Mvp	$67,615	288%
Priority Health	$67,615	288%
Geha	$68,061	290%
Western & Southern Financial Group	$73,110	311%
Blue Benefit Administrators Of Massachusetts	$86,565	368%
Blue Care Network	$86,565	368%
Blue Distinction Transplant	$86,565	368%
Blue Shield - Ca	$86,565	368%
Blue Shield - Id (Regence)	$86,565	368%
Blue Shield - Ny Highmark Northeastern	$86,565	368%
Blue Shield - Ny Highmark Western	$86,565	368%
Blue Shield - Pa (Highmark)	$86,565	368%
Blue Shield - Wa (Regence)	$86,565	368%

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 $138,404.
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 Mount Carmel East & West 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.