CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Cleveland Clinic Avon Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $21,020
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.89x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Cleveland Clinic Avon Hospital is $21,020. 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 0.89x the Medicare baseline. Located in 33300 Cleveland Clinic Blvd, Avon, OH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$21,020

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: $21,020 (89%)

Ins. Median: $21,020 (89% 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
Mmo	$17,771 - $21,020	76%
Aetna	$20,408 - $75,756	87%
Blue Cross Blue Shield	$20,408 - $37,134	87%
Devoted Health	$20,408	87%
Humana	$20,408	87%
Summacare	$20,408	87%
The Health Plan	$20,408	87%
United	$20,408 - $47,796	87%
UnitedHealthcare	$20,408	87%
Upmc	$20,408	87%
Valor	$20,408	87%
Cigna	$21,020 - $47,833	89%
Communicare	$21,428	91%
Perennial Health	$22,041	94%
Pphp	$22,449	96%
Zing Health	$22,449	96%
Medical Benefit Corp	$108,180	460%

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 Cleveland Clinic Avon 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.