CMS Price Transparency Data

Bunion correction surgery

Facility: Central Florida Lake Monroe Hospital

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $7,321
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.19x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at Central Florida Lake Monroe Hospital is $7,321. 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 $3,342.87, this hospital’s rate is 2.19x the Medicare baseline. Located in 1401 W Seminole Blvd, Sanford, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,321

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$3,342.87

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $3,342.87 (100%)

Insurance Median: $7,321 (219%)

Ins. Median: $7,321 (219% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $3,342.87 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 219% of the Medicare baseline (a markup of 119%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Corvel Corporation	$2,264 - $5,534	68%
Prime Health	$2,311 - $5,651	69%
Careworks (Rockport Community)	$2,383 - $5,826	71%
Molina Healthcare	$3,950 - $6,243	118%
Simply	$3,950	118%
Evolutions	$4,121	123%
Freedom Health	$4,575	137%
Optimum	$4,575	137%
Sunshine State Health Plan	$6,673	200%
Cigna	$7,321	219%
United	$7,389	221%
Avmed	$8,168 - $8,971	244%
Simply Healthcare	$9,252	277%
Ultimate Health Plan	$12,500	374%
Oscar	$12,883	385%
Truli For Health	$13,332	399%
Blue Cross Blue Shield	$14,130 - $28,970	423%

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 CPT Code matches exactly: 28296.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Central Florida Lake Monroe Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 28296.
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.