CMS Price Transparency Data

Bunion correction surgery

Facility: Saint Michael's Medical Center

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $5,123
Cash Discount Price: $3,794
vs. Medicare Baseline: 1.53x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at Saint Michael's Medical Center is $5,123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,794. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 1.53x the Medicare baseline. Located in 111 Central Avenue, Newark, NJ.

Cash / Self-Pay

$3,794

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,123

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: $3,794 (113%)

Insurance Median: $5,123 (153%)

Cash: $3,794 (113% of Medicare)

Ins. Median: $5,123 (153% 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
Tricare	$3,036	91%
Aetna	$3,795 - $8,044	114%
Amerihealth	$3,795	114%
Horizon	$3,795 - $7,764	114%
Humana	$3,795	114%
Medicare (plans)	$3,795	114%
New Jersey Out of State	$3,795	114%
UnitedHealthcare	$3,795 - $6,192	114%
Wellpoint Amerigroup	$3,795	114%
Wellcare	$3,908 - $5,123	117%
Clover Health	$3,946	118%
Curana	$3,984	119%
Employer Direct Healthcare	$5,312	159%
Naphcare	$5,882	176%
Cigna	$6,065	181%
Fairprice Healthcare Holdings - Fphh	$6,071	182%
Coventry	$7,589	227%

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 $3,794.
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 Saint Michael's 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.