CMS Price Transparency Data

Bunion correction surgery

Facility: AHS Hospital Corp

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $3,591
Cash Discount Price: $4,130
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at AHS Hospital Corp is $3,591. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,130. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 1.07x the Medicare baseline. Located in 651 Willow Grove St, Hackettstown, NJ.

Cash / Self-Pay

$4,130

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,591

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: $4,130 (124%)

Insurance Median: $3,591 (107%)

Cash: $4,130 (124% of Medicare)

Ins. Median: $3,591 (107% 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
Wtc Health Program [5273]	$1,032	31%
Fairos [5491]	$3,545	106%
Karen Ann Quinlan [5285]	$3,545	106%
Aetna	$3,591 - $5,028	107%
Ambetter / Centene	$3,591	107%
Amerihealth Administrators Supplemental [5512]	$3,591	107%
Amerihealth Medigap [5049]	$3,591	107%
Blue Cross Blue Shield	$3,591	107%
Champva [5354]	$3,591	107%
Cigna	$3,591	107%
Claim Watcher/Homestead [5488]	$3,591	107%
Claimdoc [5434]	$3,591	107%
Highmark Wholecare Health Plan Ip Splits [5464]	$3,591	107%
Highmark Wholecare Health Plan [5413]	$3,591	107%
Luminare Health AHS Retiree [5013]	$3,591	107%
Medicare (plans)	$3,591 - $3,717	107%
Sedgwick Wtc Health Program Wc [5514]	$3,591	107%
Tricare	$3,591	107%
UPMC [5455]	$3,591	107%
Us Family Health Plan [5258]	$3,591	107%
VA Community Care Network [5403]	$3,591	107%
Wellcare Behavioral Health [5335]	$3,591	107%
Wellcare Health Plans Ip Splits [5475]	$3,591	107%
Wellcare Health Plans [5269]	$3,591	107%
Amerihealth Caritas Vip Care Ip Splits [5460]	$3,627	108%
Amerihealth Caritas Vip Care [5313]	$3,627	108%
Kindred Giralda Hospital [5341]	$3,950	118%
Horizon Nj Health [5021]	$4,300	129%
Amerihealth [5008]	$4,845 - $5,958	145%
Cosmetic Surgery/Lap Band/Gastric Bypass [5289]	$7,806	234%
Medicaid / KanCare	$7,806	234%
Specialty Imaging [5433]	$7,806	234%

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 $4,130.
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 AHS Hospital Corp 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.