CMS Price Transparency Data

Bunion correction surgery

Facility: Clara Maass Medical Center

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $3,640
Cash Discount Price: $3,986
vs. Medicare Baseline: 1.09x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at Clara Maass Medical Center is $3,640. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,986. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 1.09x the Medicare baseline. Located in One Clara Maass Drive, Belleville, NJ.

Cash / Self-Pay

$3,986

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,640

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: $3,986 (119%)

Insurance Median: $3,640 (109%)

Cash: $3,986 (119% of Medicare)

Ins. Median: $3,640 (109% 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	$506 - $3,640	15%
Cigna	$2,261 - $3,026	68%
Wellpoint	$3,266 - $3,640	98%
Aetna	$3,640 - $6,012	109%
Clover Health	$3,640	109%
Fidelis Care	$3,640	109%
Humana	$3,640	109%
UnitedHealthcare	$3,713 - $5,982	111%
Qualcare Inc	$4,148	124%
Emblem Health	$6,370	191%
Wellcare	$7,244	217%

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 $3,986.
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 Clara Maass 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.