CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Marshfield Medical Center - Beaver Dam (Mmc-Bd)

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $28,065
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Marshfield Medical Center - Beaver Dam (Mmc-Bd) is $28,065. 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 1.19x the Medicare baseline. Located in 707 S University Ave, Beaver Dam, WI.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$28,065

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: $28,065 (119%)

Ins. Median: $28,065 (119% 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
Humana	$27,247	116%
Managed Health Services	$27,247	116%
Molina Healthcare Of Wi	$27,247	116%
Network Health Plan	$27,247	116%
Quartz	$27,247 - $39,984	116%
Security Health Plan (Shp)	$27,247	116%
UnitedHealthcare	$27,247 - $51,589	116%
Veteran'S Administration (Va Ccn)	$27,247	116%
Blue Cross Blue Shield	$28,065 - $81,872	119%
Group Health Cooperative Of Eau Claire	$28,882	123%
Icare	$29,154	124%
The Alliance	$50,012	213%

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 Marshfield Medical Center - Beaver Dam (Mmc-Bd) 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.