The cost of 1 and 2-level anterior cervical discectomy and fusion (ACDF) in inpatient (n = 46,996) and ambulatory settings (n = 3,315) were compared in a retrospective review of multiple State Inpatient and Ambulatory Databases. Outpatient ACDF was associated with 5.4% rate of postoperative ED visits, 1.6% readmission rate, and 0.2% re-operation rate, compared to 5.5%, 3.8%, and 0.4% respectively for inpatient ACDF. In comparing all primary variables between the 2 patient populations, ambulatory ACDF was non-inferior to inpatient ACDF (p < 0.0001). In addition, overall charges were significantly lower in the ambulatory setting ($33,362.51 vs $74,667.04; p < 0.0001). While an ACDF has typically been performed in the hospital followed by at least a 1 day inpatient hospitalization, this study displays a comparable safety profile for ambulatory surgery with a significantly lower cost.