CMS Price Transparency Data

Bunion correction surgery

Facility: UMass Memorial Health - Harrington Hospital

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $4,168
Cash Discount Price: $21,302
vs. Medicare Baseline: 1.25x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at UMass Memorial Health - Harrington Hospital is $4,168. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $21,302. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 1.25x the Medicare baseline. Located in 100 South Street, Southbridge, MA.

Cash / Self-Pay

$21,302

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,168

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: $21,302 (637%)

Insurance Median: $4,168 (125%)

Cash: $21,302 (637% of Medicare)

Ins. Median: $4,168 (125% 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
Fallon Connectorcare [10503]	$578	17%
Hsno/Free Care [10801]	$681	20%
Harvard Pilgrim [10701]	$2,396	72%
Blue Cross Blue Shield	$3,000 - $9,096	90%
Champva [11001]	$3,853 - $8,484	115%
Cigna	$3,970 - $8,804	119%
Institution [10406]	$3,970 - $8,804	119%
Mgb Mcr [10124]	$3,970 - $8,804	119%
Tufts Us Family [11203]	$3,970 - $8,804	119%
Aetna	$4,168 - $9,244	125%
Commonwealth Care Alliance [10103]	$4,168 - $9,244	125%
Fallon Mcr Supp [20202]	$4,168 - $9,244	125%
Fallon Mcr [10105]	$4,168 - $9,244	125%
Tufts Mcr [10112]	$4,168 - $9,244	125%
UnitedHealthcare	$4,168 - $9,420	125%
Senior Whole Health [10110]	$4,248 - $9,420	127%
Tufts Connectorcare [10507]	$6,753 - $14,975	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 $21,302.
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 Health - Harrington 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.