CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: St Clair Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $40,095
Cash Discount Price: $23,651
vs. Medicare Baseline: 1.71x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at St Clair Hospital is $40,095. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $23,651. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.71x the Medicare baseline. Located in 1000 Bower Hill Road, Pittsburgh, PA.

Cash / Self-Pay

$23,651

Average discount available for prompt cash payment at this facility.

Insurance Median

$40,095

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: $23,651 (101%)

Insurance Median: $40,095 (171%)

Cash: $23,651 (101% of Medicare)

Ins. Median: $40,095 (171% 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
Highmark	$20,585 - $40,095	88%
Amerihealth	$22,834	97%
Humana	$22,834	97%
UnitedHealthcare	$22,834 - $41,272	97%
Pa Health And Wellness	$23,291	99%
Aetna	$23,519 - $45,814	100%
The Health Plan	$23,976 - $51,377	102%
Cigna	$24,204 - $43,610	103%
Geisinger	$24,204	103%
Upmc	$24,302 - $34,908	103%
Health Partners	$24,433	104%

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 $23,651.
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 St Clair 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.