CMS Price Transparency Data

Bunion correction surgery

Facility: Mt Sinai Hospital Medical Center

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $3,506
Cash Discount Price: $1,530
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at Mt Sinai Hospital Medical Center is $3,506. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,530. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 1.05x the Medicare baseline. Located in 15Th Street at California, Chicago, IL.

Cash / Self-Pay

$1,530

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,506

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%)

Cash / Self-Pay: $1,530 (46%)

Insurance Median: $3,506 (105%)

Cash: $1,530 (46% of Medicare)

Ins. Median: $3,506 (105% 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.

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
Partners In Hlth - All Plans	$874	26%
Blue Cross Blue Shield	$977 - $8,094	29%
Compsych Ip/Op Only - All Plans	$1,311	39%
Healthlink Hmo	$1,420	42%
Hfn Platinum	$1,420	42%
Healthlink Ppo - All Other Plans	$1,530	46%
Multiplan Primary Ntwrk/Phcs - All Other Plans	$1,530	46%
Hfn Epo	$1,748	52%
Multiplan Complementary Ntwrk	$1,748	52%
Hfn Ppo - All Other Plans	$1,923	58%
Ambetter / Centene	$2,295 - $3,857	69%
Oscar - All Plans	$2,404	72%
Cigna	$2,701 - $8,499	81%
Tricare	$3,401	102%
Va Healthnet - All Plans	$3,401	102%
Advocate Physician Prtnrs Mcr	$3,506	105%
Cenpatico Illinicare Dual	$3,506	105%
Cenpatico Illinicare Mcr - All Other Plans	$3,506	105%
Humana	$3,506 - $6,862	105%
Lawndale Christian - All Plans	$3,506	105%
Meridian/Harmony D-Snp - All Plans	$3,506	105%
Nextlevel Hlth Icp Fhp Aca - All Plans	$3,506	105%
Harmony Behavioral Htlh - All Plans	$3,612	108%
Zing Mcr Adv - All Plans	$3,647	109%
Molina Mcr - All Other Plans	$3,682	110%
Advocate Physician Prtnrs - All Other Plans	$3,857	115%
Aetna	$4,939 - $8,094	148%
Family Health Network Mcaid - All Plans	$8,094	242%
Molina Mcaid	$8,499	254%

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 $1,530.
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 Mt Sinai Hospital Medical Center 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.