CMS Price Transparency Data

Bunion correction surgery

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $3,970
Cash Discount Price: $27,091
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at UMass Memorial Healthalliance Hospitals is $3,970. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $27,091. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 1.19x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$27,091

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,970

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: $27,091 (810%)

Insurance Median: $3,970 (119%)

Cash: $27,091 (810% of Medicare)

Ins. Median: $3,970 (119% 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
Hsno/Free Care [10801]	$294	9%
Fallon Connectorcare [10503]	$578	17%
Workers Compensation [20501]	$1,315	39%
Harvard Pilgrim [10701]	$2,361	71%
Blue Cross Blue Shield	$3,000 - $4,102	90%
Champva [11001]	$3,468	104%
Cigna	$3,970 - $6,193	119%
Correctional Care [11003]	$3,970	119%
Institution [10406]	$3,970	119%
Medicaid / KanCare	$3,970	119%
Medicare (plans)	$3,970	119%
Tufts Dual [10111]	$3,970	119%
Tufts Us Family [11203]	$3,970	119%
Aetna	$4,168	125%
Commonwealth Care Mcr [10115]	$4,168	125%
Fallon Mcr Supp [20202]	$4,168	125%
Harvard Pilgrim Mcr [10106]	$4,168	125%
Mgb Mcr [10124]	$4,168	125%
Tufts Mcr [10112]	$4,168	125%
UnitedHealthcare	$4,168 - $4,248	125%
Senior Whole Health [10110]	$4,248	127%
Tufts [11201]	$5,630	168%
Tufts Connectorcare [10507]	$6,753	202%

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 $27,091.
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 UMass Memorial Healthalliance Hospitals 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.