CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Thedacare Regional Medical Center - Appleton Inc

Billing Code: 451 (MS-DRG)

The BaseRate · fair price medium confidence

A fair price for this

$29,003

about 1.2× the $23,504 Medicare rate · typically $13,336–$45,481

modeled estimate · not a bill or quote

What this hospital charges insurers

$35,874

Above the fair price

about $6,871 over the fair price · 1.5× Medicare

Medicare pays $23,504 Fair price $29,003 This hospital $35,874 Cash price $23,122 Hospital's list price $41,288

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

Highest price of the 9 WI hospitals we have prices for — worth calling around.

Cheapest $15,202 Priciest $35,874

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

A fair price for a Spinal fusion, single level (inpatient stay) is about $29,003 (about 1.2× the $23,504 Medicare rate). Thedacare Regional Medical Center - Appleton Inc charges insurers about $35,874, or about $23,122 in cash — above the fair price. Located in Appleton, WI.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $29,003. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

3 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Humana AetnaCignaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$21,521 - $44,911	92%
Blue Cross Blue Shieldmajor	$34,397 - $46,944	146%
Humanamajor	$37,350	159%
HealthPartners	$21,486	91%

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 23,122), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the MS-DRG code on your bill matches exactly: 451.

Insurance Before you use insurance

Call your insurance company to confirm Thedacare Regional Medical Center - Appleton Inc is in-network.
Ask your insurer whether prior approval is required for MS-DRG code 451.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Thedacare Regional Medical Center - Appleton Inc

Compare: Spinal fusion, single level (inpatient stay) at other WI hospitals

Ascension Sacred Heart Rehabilitation Hospital · Mequon $15,202
Ascension Columbia St Marys Hospital Milwaukee · Milwaukee $15,215
Orthopaedic Hospital of Wisconsin · Glendale $22,143
Thedacare Regional Med Ctr - Neenah · Neenah $22,570
Sauk Prairie Hospital · Prairie Du Sac $22,833
Oakleaf Surgical Hospital · Altoona $22,877
The Monroe Clinic · Monroe $22,975
Mile Bluff Medical Center · Mauston $23,232

Insurance negotiated median for the same procedure, sorted lowest first.