CMS Price Transparency Data

Bunion correction surgery

Facility: St Mary's General Hospital

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $5,196
Cash Discount Price: $3,868
vs. Medicare Baseline: 1.55x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at St Mary's General Hospital is $5,196. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,868. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 1.55x the Medicare baseline. Located in 350 Boulevard, Passaic, NJ.

Cash / Self-Pay

$3,868

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,196

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: $3,868 (116%)

Insurance Median: $5,196 (155%)

Cash: $3,868 (116% of Medicare)

Ins. Median: $5,196 (155% 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
Wellchoice	$1,715 - $1,978	51%
Humana	$3,095	93%
Aetna	$3,868 - $8,201	116%
Amerihealth	$3,868	116%
Clover Health	$3,868	116%
Horizon	$3,868 - $6,858	116%
Medicare (plans)	$3,868	116%
Tricare	$3,868	116%
UnitedHealthcare	$3,868 - $5,709	116%
Wellcare	$3,868 - $5,222	116%
Wellpoint Amerigroup	$3,868	116%
Ally-Align (Fka Spartan Plan Nj, Inc.)	$4,062	122%
Employer Direct Healthcare	$5,415	162%
Cigna	$5,684	170%
Fairprice Healthcare Holdings	$6,189	185%
Coventry	$7,736	231%

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 $3,868.
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 St Mary's General 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.