CMS Price Transparency Data

Bunion correction surgery

Facility: Down East Community Hospital

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $1,604
Cash Discount Price: $1,447
vs. Medicare Baseline: 0.48x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at Down East Community Hospital is $1,604. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,447. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 0.48x the Medicare baseline. Located in 11 Hospital Drive, Machias, ME.

Cash / Self-Pay

$1,447

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,604

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: $1,447 (43%)

Insurance Median: $1,604 (48%)

Cash: $1,447 (43% of Medicare)

Ins. Median: $1,604 (48% 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
Blue Cross Blue Shield	$849 - $1,557	25%
Humana	$849	25%
Wellcare	$849	25%
Partners Direct Health	$965	29%
Community Health Options	$1,597	48%
Aetna	$1,611	48%
UnitedHealthcare	$1,659	50%
Martins Point	$1,736	52%
Patients Advocates	$1,736	52%
Cigna	$1,740	52%
Harvard Pilgrim	$1,765	53%

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 $1,447.
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 Down East Community 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.