CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Geisinger-Community Medical Center

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $57,178
Cash Discount Price: $174,339
vs. Medicare Baseline: 2.43x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Geisinger-Community Medical Center is $57,178. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $174,339. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 2.43x the Medicare baseline. Located in 1822 Mulberry Street, Scranton, PA.

Cash / Self-Pay

$174,339

Average discount available for prompt cash payment at this facility.

Insurance Median

$57,178

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: $174,339 (742%)

Insurance Median: $57,178 (243%)

Cash: $174,339 (742% of Medicare)

Ins. Median: $57,178 (243% 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 243% of the Medicare baseline (a markup of 143%). 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
Geisinger Health Plan	$18,913 - $43,379	80%
Medicare (plans)	$18,913	80%
Humana	$19,291	82%
Aetna	$19,859 - $165,903	84%
Blue Cross Blue Shield	$21,858 - $82,373	93%
Cigna	$29,508	126%
Ambetter / Centene	$44,446	189%
UnitedHealthcare	$69,586	296%
Christian Healthcare Ministries	$140,596	598%
Healthnet	$164,778	701%
Universal Managed Care	$182,775	778%
Intergroup Services	$224,953 - $253,073	957%
Multiplan	$239,013	1017%

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 $174,339.
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 Geisinger-Community 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.