CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Mercy Health St Ritas Medical Center

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $23,980
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Mercy Health St Ritas Medical Center is $23,980. 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 1.02x the Medicare baseline. Located in 730 West Market Street, Lima, OH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$23,980

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: $23,980 (102%)

Ins. Median: $23,980 (102% 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
Aetna	$23,861	102%
Blue Cross Blue Shield	$23,861 - $74,587	102%
Buckeye Mycare Benefits [4237]	$23,861	102%
Humana	$23,861	102%
Medigold [4435]	$23,861	102%
UnitedHealthcare	$23,861 - $37,701	102%
Devoted Health Plan [4501]	$24,100	103%
Medicare (plans)	$24,100	103%
Caresource Mycare Ohio [4236]	$24,338	104%
Molina Mycare Ohio [4235]	$25,054	107%
Paramount Elite [3723]	$26,251	112%
Buckeye [4178]	$40,689	173%
Caresource [4179]	$45,939	195%
Medical Mutual [3067]	$76,157	324%

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 Mercy Health St Ritas Medical Center 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.