CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Bethesda North

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $38,067
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.62x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Bethesda North is $38,067. 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 1.62x the Medicare baseline. Located in 10500 Montgomery Road, Cincinnati, OH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$38,067

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: $38,067 (162%)

Ins. Median: $38,067 (162% 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	$24,714 - $56,506	105%
Blue Cross Blue Shield	$24,714 - $63,923	105%
Caresource	$24,714	105%
Essence Healthcare	$24,714	105%
Humana	$24,714	105%
Medigold	$24,714	105%
Molina	$24,714	105%
UnitedHealthcare	$24,714 - $65,800	105%
Medical Mutual Of Ohio	$25,208 - $67,751	107%
Buckeye	$25,456 - $35,835	108%
Wellcare	$25,456	108%
Oscar	$32,136	137%
Cigna	$49,483	211%
Imagine Health	$59,272	252%
Custom Design Benefits	$60,797 - $64,009	259%
Medben	$67,717 - $71,177	288%

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 Bethesda North 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.