CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Forbes Hospital

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $23,401
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.00x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Forbes Hospital is $23,401. 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 1.00x the Medicare baseline. Located in 2570 Haymaker Road, Monroeville, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$23,401

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: $23,401 (100%)

Ins. Median: $23,401 (100% 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	$11,968 - $42,107	51%
Life Pittsburgh	$21,870	93%
The Health Plan Of The Upper Ohio Valley	$21,870 - $24,057	93%
UnitedHealthcare	$21,870 - $23,620	93%
Aetna	$22,745 - $52,206	97%
Amerihealth	$22,964	98%
Geisinger	$22,964	98%
Highmark Wholecare	$23,183	99%
Humana	$23,183	99%
Medicare (plans)	$23,183 - $25,370	99%
Cigna	$23,401 - $51,200	100%
Jefferson Health Plans	$23,620	100%
Molina	$23,839	101%
American Health Plans	$24,057	102%
University Of Pittsburgh Medical Center	$24,713	105%
Martin'S Point	$31,029	132%
Medical Mutual	$51,200	218%

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 Forbes 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.